Provider Demographics
NPI:1033316179
Name:DANIELSON, STACIA LINN (ARNP, LISW, IADC)
Entity Type:Individual
Prefix:MS
First Name:STACIA
Middle Name:LINN
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:ARNP, LISW, IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 9TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2929
Mailing Address - Country:US
Mailing Address - Phone:319-483-4074
Mailing Address - Fax:319-483-1378
Practice Address - Street 1:312 9TH ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2929
Practice Address - Country:US
Practice Address - Phone:319-483-4074
Practice Address - Fax:319-483-1378
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0069151041C0700X
IAG135058363LP0808X
IA10028101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)