Healthcare Provider Details

I. General information

NPI: 1609790484
Provider Name (Legal Business Name): MICHELLE HEATHER DANIELS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9021 OGDEN AVE
BROOKFIELD IL
60513-2040
US

IV. Provider business mailing address

130 S PICK AVE
ELMHURST IL
60126-3016
US

V. Phone/Fax

Practice location:
  • Phone: 708-354-4547
  • Fax:
Mailing address:
  • Phone: 630-269-4219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.114238
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: