Provider Demographics
NPI:1114353174
Name:WHITE, DANNIELLE MARIE FLADTEN (LICSW, CPRP)
Entity Type:Individual
Prefix:MRS
First Name:DANNIELLE
Middle Name:MARIE FLADTEN
Last Name:WHITE
Suffix:
Gender:F
Credentials:LICSW, CPRP
Other - Prefix:
Other - First Name:DANNIELLE
Other - Middle Name:MARIE
Other - Last Name:FLADTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:312 COUNTY ROAD D E
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55117-1275
Mailing Address - Country:US
Mailing Address - Phone:651-600-7876
Mailing Address - Fax:
Practice Address - Street 1:312 COUNTY ROAD D E
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55117-1275
Practice Address - Country:US
Practice Address - Phone:651-600-7876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2018-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN184631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1114353174Medicaid