Provider Demographics
NPI:1235860495
Name:DUELL, DELANEY RAYE
Entity Type:Individual
Prefix:
First Name:DELANEY
Middle Name:RAYE
Last Name:DUELL
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 1:1062 OAK FOREST DR STE 120
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-3501
Mailing Address - Country:US
Mailing Address - Phone:608-790-9481
Mailing Address - Fax:
Practice Address - Street 1:1062 OAK FOREST DR STE 120
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-3501
Practice Address - Country:US
Practice Address - Phone:608-790-9481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician