Provider Demographics
NPI:1285251181
Name:DUPRE, DANIELLE DUPUIS (AUD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:DUPUIS
Last Name:DUPRE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 THREE LAKES PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0642
Mailing Address - Country:US
Mailing Address - Phone:903-747-4050
Mailing Address - Fax:903-474-4075
Practice Address - Street 1:2210 THREE LAKES PKWY STE 100
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0642
Practice Address - Country:US
Practice Address - Phone:903-747-4050
Practice Address - Fax:903-474-4075
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81269231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist