Healthcare Provider Details

I. General information

NPI: 1821781477
Provider Name (Legal Business Name): DANIELLE PAIGE SNOW LMSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W CENTRE AVE
PORTAGE MI
49024-5309
US

IV. Provider business mailing address

8108 PERRY ST
PORTAGE MI
49024-5427
US

V. Phone/Fax

Practice location:
  • Phone: 269-779-7577
  • Fax:
Mailing address:
  • Phone: 269-330-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801121568
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: