Provider Demographics
NPI:1780702027
Name:HENDRIX, DANIEL BRIAN (MS, CCC-A)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:BRIAN
Last Name:HENDRIX
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21 HIGHLAND AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3872
Mailing Address - Country:US
Mailing Address - Phone:978-462-6250
Mailing Address - Fax:978-225-6112
Practice Address - Street 1:21 HIGHLAND AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3872
Practice Address - Country:US
Practice Address - Phone:978-462-6250
Practice Address - Fax:978-225-6112
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA702237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5104157Medicaid
MA5104157Medicaid