Healthcare Provider Details

I. General information

NPI: 1033316179
Provider Name (Legal Business Name): STACIA LINN DANIELSON ARNP, LISW, IADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 9TH ST SW
WAVERLY IA
50677-2929
US

IV. Provider business mailing address

312 9TH ST SW
WAVERLY IA
50677-2929
US

V. Phone/Fax

Practice location:
  • Phone: 319-483-4074
  • Fax: 319-483-1378
Mailing address:
  • Phone: 319-483-4074
  • Fax: 319-483-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG135058
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10028
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006915
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: