Provider Demographics
NPI:1285083345
Name:NOVASCONE, DANIELLE RAE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RAE
Last Name:NOVASCONE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19614 W 97TH TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66220-3347
Mailing Address - Country:US
Mailing Address - Phone:913-481-2352
Mailing Address - Fax:
Practice Address - Street 1:19614 W 97TH TER
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66220-3347
Practice Address - Country:US
Practice Address - Phone:913-481-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2791235Z00000X
MO2016023443235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist