Provider Demographics
NPI:1093426793
Name:FANSLOW, DANIELLE ELIZABETH (BSW, LADC)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:ELIZABETH
Last Name:FANSLOW
Suffix:
Gender:F
Credentials:BSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 WOODLAKE DR SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-6242
Mailing Address - Country:US
Mailing Address - Phone:507-289-2089
Mailing Address - Fax:507-535-5798
Practice Address - Street 1:29 7TH ST NE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-3644
Practice Address - Country:US
Practice Address - Phone:507-289-2089
Practice Address - Fax:507-535-5798
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306546101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)