Healthcare Provider Details

I. General information

NPI: 1659036416
Provider Name (Legal Business Name): DANIEL SIMONSON MS, LP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11157 ZEALAND AVE N
CHAMPLIN MN
55316-3595
US

IV. Provider business mailing address

11157 ZEALAND AVE N
CHAMPLIN MN
55316-3595
US

V. Phone/Fax

Practice location:
  • Phone: 763-639-7462
  • Fax:
Mailing address:
  • Phone: 763-639-7462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: