Provider Demographics
NPI:1124458518
Name:BROADWAY, DANIELLE (BS SLP ASSISTANT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BROADWAY
Suffix:
Gender:
Credentials:BS SLP ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 FM 663
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5606
Mailing Address - Country:US
Mailing Address - Phone:469-550-9913
Mailing Address - Fax:469-461-0765
Practice Address - Street 1:3851 FM 663
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5606
Practice Address - Country:US
Practice Address - Phone:469-550-9913
Practice Address - Fax:469-461-0765
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX362482355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant