Provider Demographics
NPI:1154652212
Name:DANIELS, JENNA K (MSSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:K
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-2120
Mailing Address - Country:US
Mailing Address - Phone:920-206-9888
Mailing Address - Fax:920-206-3797
Practice Address - Street 1:507 MARGARET ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098-2541
Practice Address - Country:US
Practice Address - Phone:920-206-9888
Practice Address - Fax:920-206-3797
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI500121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker