Provider Demographics
NPI:1144530171
Name:HAASE, DANA SMITH (M ED)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:SMITH
Last Name:HAASE
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3874 NW ARCHER ST
Mailing Address - Street 2:APT 101
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4813
Mailing Address - Country:US
Mailing Address - Phone:386-292-0502
Mailing Address - Fax:
Practice Address - Street 1:105 S.W. 140TH TERRACE
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32669
Practice Address - Country:US
Practice Address - Phone:352-333-3995
Practice Address - Fax:352-333-3994
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 4987235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist