Provider Demographics
NPI:1407372998
Name:SHREVE, DANIELLE ALYSON
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ALYSON
Last Name:SHREVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2565
Mailing Address - Country:US
Mailing Address - Phone:419-947-1900
Mailing Address - Fax:
Practice Address - Street 1:7819 STATE ROUTE 19
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833
Practice Address - Country:US
Practice Address - Phone:419-947-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.13190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14147790OtherAMERICAN SPEECH-LANGUAGE AND HEARING ASSOCIATION CERTIFICATION