MEDICARE: DR. ELIZABETH DANIELSON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669514329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH DANIELSON PH.D.

Provider Business Mailing Address
First Line	:	1025 N COUNTRY CLUB DR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-3307
Country	:	US
Telephone Number	:	480-472-9028
Fax Number	:

Provider Business Practice Location Address
First Line	:	3120 N RED MOUNTAIN
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-1068
Country	:	US
Telephone Number	:	480-472-8736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/08/2007

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