Healthcare Provider Details

I. General information

NPI: 1053996306
Provider Name (Legal Business Name): DANIELLE NORGREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 FERNBROOK LN N
PLYMOUTH MN
55447-5352
US

IV. Provider business mailing address

1100 GLENWOOD AVE
MINNEAPOLIS MN
55405-1430
US

V. Phone/Fax

Practice location:
  • Phone: 612-268-5858
  • Fax:
Mailing address:
  • Phone: 612-871-1454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: