Healthcare Provider Details

I. General information

NPI: 1689500084
Provider Name (Legal Business Name): DANIELLE J PAULSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 MENASHA AVE
MANITOWOC WI
54220-1745
US

IV. Provider business mailing address

2104 MENASHA AVE
MANITOWOC WI
54220-1745
US

V. Phone/Fax

Practice location:
  • Phone: 920-645-7649
  • Fax:
Mailing address:
  • Phone: 920-645-7649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1204-228
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: