Provider Demographics
NPI:1104004951
Name:BURCHBY, DANEL
Entity Type:Individual
Prefix:
First Name:DANEL
Middle Name:
Last Name:BURCHBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 JEWELERS PARK DR
Mailing Address - Street 2:STE 200
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3893
Mailing Address - Country:US
Mailing Address - Phone:920-720-6000
Mailing Address - Fax:920-486-6013
Practice Address - Street 1:40 JEWELERS PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3893
Practice Address - Country:US
Practice Address - Phone:920-720-6000
Practice Address - Fax:920-486-6013
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9663-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical