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General NPI Number Information
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NPI Number | 1003073669
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Entity Type | Individual
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Provider Name | DANIELLE S CARLSON MSW
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Gender | Female
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 10702 W BURLEIGH ST
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City | WAUWATOSA
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State | WI
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Zip | 53222-3310
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Country | US
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Telephone | 414-777-0740
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Fax | 414-777-0749
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Provider Business Mailing Address
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Address Line | 10702 W BURLEIGH ST
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City | WAUWATOSA
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State | WI
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Zip | 53222-3310
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Country | US
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Telephone | 414-777-0740
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Fax | 414-777-0749
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7635-123
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.012652
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License Number State | IL
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