Healthcare Provider Details

I. General information

NPI: 1962369397
Provider Name (Legal Business Name): DANIELLE RAISA ARNTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3139 N LINCOLN AVE STE 202
CHICAGO IL
60657-3122
US

IV. Provider business mailing address

3139 N LINCOLN AVE STE 202
CHICAGO IL
60657-3122
US

V. Phone/Fax

Practice location:
  • Phone: 773-998-1624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.022633
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: