Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 149.012652 | IL |
Y | 1041C0700X | Clinical Social Worker | 7635-123 | WI |
NPI | 1003073669 |
---|---|
Provider Name | Danielle S Carlson |
First Address | Wauwatosa, WI 53222-3310 |
Second Address | Wauwatosa, WI 53222-3310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 21/12/2016 |