Healthcare Provider Details

I. General information

NPI: 1669802625
Provider Name (Legal Business Name): DANIELA WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 WAYZATA BLVD STE 200
MINNETONKA MN
55305-1810
US

IV. Provider business mailing address

4037 HUNTINGTON CIR
SAVAGE MN
55378-4102
US

V. Phone/Fax

Practice location:
  • Phone: 952-206-2040
  • Fax:
Mailing address:
  • Phone: 612-500-8049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number305280
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: