Provider Demographics
NPI:1043562648
Name:CASPER, DANIELLE (LMFT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:CASPER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:MACKENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 19070
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54307-9070
Mailing Address - Country:US
Mailing Address - Phone:920-496-4700
Mailing Address - Fax:
Practice Address - Street 1:3860 MONROE RD
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-8399
Practice Address - Country:US
Practice Address - Phone:920-496-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2024-03-14
Deactivation Date:2014-08-08
Deactivation Code:
Reactivation Date:2015-05-22
Provider Licenses
StateLicense IDTaxonomies
WI1136-124106H00000X
WI458-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100044971Medicaid