Provider Demographics
NPI:1255300174
Name:COLEGROVE, DANIELLE ANNE (MS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:ANNE
Last Name:COLEGROVE
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7843 KENNETH AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3505
Mailing Address - Country:US
Mailing Address - Phone:847-679-2037
Mailing Address - Fax:
Practice Address - Street 1:1501 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60208-0840
Practice Address - Country:US
Practice Address - Phone:847-467-2406
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer