Provider Demographics
NPI:1538223565
Name:WARTMAN, DARA EILEEN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:DARA
Middle Name:EILEEN
Last Name:WARTMAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 WATERSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4482
Mailing Address - Country:US
Mailing Address - Phone:972-359-1110
Mailing Address - Fax:
Practice Address - Street 1:1283 WATERSIDE CIR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-4482
Practice Address - Country:US
Practice Address - Phone:972-359-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101664235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist