Doctor Name: | COLLEEN M DANIEWICZ |
NPI Number: | 1033171145 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSYD |
License Number: | LP3532 |
Business Practice Address: | 8675 Valley Creek Rd Woodbury, MN - 551252337 |
Business Phone Number: | 6515013000 |
Business Fax Number: | 6515013500 |
Mailing Address: | Po Box 43, Mr 10809 MINNEAPOLIS |
State: | MN |
Postal Code: | 554400043 |
Phone Number: | 6122624813 |
Fax Number: | 6122624191 |
NPI Enumeration Date: | 04/04/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | LP3532 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |