Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 10028 | IA |
N | 1041C0700X | Clinical Social Worker | 006915 | IA |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | G135058 | IA |
NPI | 1033316179 |
---|---|
Provider Name | Ms. Stacia Linn Danielson |
First Address | Waverly, IA 50677-2929 |
Second Address | Waverly, IA 50677-2929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 27/07/2016 |