| Doctor Name: | DR. JILL M. WOLLENZIEN-DANIELS |
| NPI Number: | 1730227885 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 2273-057 |
| Business Practice Address: | 2290 Rickie Dr Mosinee, WI - 544558848 |
| Business Phone Number: | 7152982104 |
| Business Fax Number: | |
| Mailing Address: | 2290 Rickie Dr, MOSINEE |
| State: | WI |
| Postal Code: | 544558848 |
| Phone Number: | 7152982104 |
| Fax Number: | |
| NPI Enumeration Date: | 02/01/2007 |
| NPI Last Update Date: | 02/11/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TA0400X |
| License Number: | 2273-057 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |