Healthcare Provider Details

I. General information

NPI: 1659046449
Provider Name (Legal Business Name): DANIELLE GARDNER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE CASWELL

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1363 W SPRUCE AVE
WASILLA AK
99654-5327
US

IV. Provider business mailing address

PO BOX 872954
WASILLA AK
99687-2954
US

V. Phone/Fax

Practice location:
  • Phone: 907-376-2411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number217377
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: