Individual
KODI DANIELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
104 JV MANGUBAT DR, WAYNESBORO, TN 38485-2439
(931) 722-3641
Mailing address
104 JV MANGUBAT DR, WAYNESBORO, TN 38485-2439
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3050
TN
Other
Enumeration date
02/25/2016
Last updated
02/25/2016
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