Active NPI
Danielle Marie Wallner, SLP
- Speech-Language Pathologist
- Eagle, ID
National Provider Identifier
1225239783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP-1131
- Practice address
- 77 N Fisher Park Way
Eagle, ID 83616-4796 - Phone
- (208) 378-5430
- NPI assigned
- May 30, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP-1131 | ID | Primary |
Addresses
Primary practice location
77 N Fisher Park Way
Eagle, ID 83616-4796
Mailing address
2965 E Tarpon Dr Ste 150
Meridian, ID 83642-9007
Phone (208) 287-9420
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225239783 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP-1131 | ID | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524528000000",
"number": "1225239783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2965 E TARPON DR STE 150",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836429007",
"telephone_number": "208-287-9420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "77 N FISHER PARK WAY",
"city": "EAGLE",
"state": "ID",
"postal_code": "836164796",
"telephone_number": "208-378-5430"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLNER",
"first_name": "DANIELLE",
"middle_name": "MARIE",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-30",
"last_updated": "2018-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ID",
"license": "SLP-1131",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1225239783",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eagle, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.