Provider Demographics
NPI:1316230105
Name:DANIELS, ANTOINETTE (SLPA, LAC)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:DANIELS
Suffix:
Gender:
Credentials:SLPA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1487 W KEISER AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:AR
Mailing Address - Zip Code:72370-2806
Mailing Address - Country:US
Mailing Address - Phone:870-822-0087
Mailing Address - Fax:
Practice Address - Street 1:315 E UNION AVE
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370-3235
Practice Address - Country:US
Practice Address - Phone:870-563-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2355S0801X
ARA2503011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR187339721Medicaid