MEDICARE: MR. DANNY LEE CORRELL MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	7105-123	WI

General Provider Information

NPI Number	:	1902848682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANNY LEE CORRELL MSW, LCSW

Provider Business Mailing Address
First Line	:	3126 BAXTER AVE
Second Line	:
City	:	SUPERIOR
State	:	WI
Zip	:	54880-5500
Country	:	US
Telephone Number	:	218-260-7035
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 TOWER AVE
Second Line	:	TWIN PORTS VA OUTPATIENT CLINIC
City	:	SUPERIOR
State	:	WI
Zip	:	54880-5335
Country	:	US
Telephone Number	:	715-398-2943
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	07/08/2007

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