Healthcare Provider Details

I. General information

NPI: 1104055615
Provider Name (Legal Business Name): DANIELLE WRIGHT STANDISH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 N 10TH ST SUITE 110
KALAMAZOO MI
49009-5733
US

IV. Provider business mailing address

1090 N 10TH ST SUITE 110
KALAMAZOO MI
49009-5733
US

V. Phone/Fax

Practice location:
  • Phone: 269-375-4363
  • Fax:
Mailing address:
  • Phone: 269-375-4363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301012835
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: