Provider Demographics
NPI:1043942600
Name:DANIELSON, KATHERINE LILLIAN (MA)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:LILLIAN
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:LILLIAN
Other - Last Name:DANIELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:160 S 68TH ST STE 1101
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8304
Mailing Address - Country:US
Mailing Address - Phone:515-782-2161
Mailing Address - Fax:
Practice Address - Street 1:160 S 68TH ST STE 1101
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8304
Practice Address - Country:US
Practice Address - Phone:515-782-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA114706235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist