Healthcare Provider Details

I. General information

NPI: 1679086359
Provider Name (Legal Business Name): RACHEL MARIE WASSERMAN DANIELS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL MARIE WASSERMAN PHD

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 OAKLAND DR
KALAMAZOO MI
49008-1282
US

IV. Provider business mailing address

1000 OAKLAND DR
KALAMAZOO MI
49008-1282
US

V. Phone/Fax

Practice location:
  • Phone: 269-337-4400
  • Fax: 269-337-6474
Mailing address:
  • Phone: 269-337-4400
  • Fax: 269-337-6471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019432
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY9853
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: