Provider Demographics
NPI:1811178478
Name:GIFFORD, DANIEL MARK (MS CCCSLP)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:MARK
Last Name:GIFFORD
Suffix:
Gender:M
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 N MILWAUKEE ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-5803
Mailing Address - Country:US
Mailing Address - Phone:888-389-9030
Mailing Address - Fax:
Practice Address - Street 1:1701 SHARP RD
Practice Address - Street 2:LAKEVIEW SPECIALTY HOSPITAL
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185
Practice Address - Country:US
Practice Address - Phone:262-534-7297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI464154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist