Provider Demographics
NPI:1073659991
Name:JONAS, DANIEL (DMIN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:JONAS
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 N MARLBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1303
Mailing Address - Country:US
Mailing Address - Phone:414-964-1837
Mailing Address - Fax:
Practice Address - Street 1:4465 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-1662
Practice Address - Country:US
Practice Address - Phone:414-453-6960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39-124106H00000X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral