Provider Demographics
NPI:1306112404
Name:DAINES, PAUL MARK (AUD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MARK
Last Name:DAINES
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-3932
Mailing Address - Country:US
Mailing Address - Phone:435-753-4327
Mailing Address - Fax:435-213-9754
Practice Address - Street 1:485 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-3932
Practice Address - Country:US
Practice Address - Phone:435-753-4327
Practice Address - Fax:435-213-9754
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7447284-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist