Provider Demographics
NPI:1962961987
Name:DUBOIS, DANIELLE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 EAGLES TRACE PATH APT C
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1113
Mailing Address - Country:US
Mailing Address - Phone:410-422-2899
Mailing Address - Fax:
Practice Address - Street 1:1317 EAGLES TRACE PATH APT C
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1113
Practice Address - Country:US
Practice Address - Phone:410-422-2899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202010428235Z00000X
MD08808235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist