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General NPI Number Information
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NPI Number | 1972163004
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Entity Type | Individual
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Provider Name | DANIELLE R. EBBEN LCSW, SAC
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Gender | Female
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 12/07/2025
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Provider Practice Location Address
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Address Line | 4868 HIGH CROSSING BLVD
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City | MADISON
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State | WI
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Zip | 53704-7403
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Country | US
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Telephone | 608-274-8294
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 HUMES RD STE 100
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City | JANESVILLE
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State | WI
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Zip | 53545-0491
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Country | US
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Telephone | 608-741-2117
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Fax | 608-758-5761
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16399-131
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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 | 9809-123
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License Number State | WI
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