Provider Demographics
NPI:1700309770
Name:REESE, DARA HOPE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DARA
Middle Name:HOPE
Last Name:REESE
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 1:32 EASTLAKE DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-1520
Mailing Address - Country:US
Mailing Address - Phone:941-809-4509
Mailing Address - Fax:
Practice Address - Street 1:32 EASTLAKE DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-1520
Practice Address - Country:US
Practice Address - Phone:941-809-4509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7464235Z00000X
NC12436235Z00000X
MD10363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist