Provider Demographics
NPI:1265664346
Name:FRASER, DANIELLE ERIN
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ERIN
Last Name:FRASER
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 1:412 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48216-1412
Mailing Address - Country:US
Mailing Address - Phone:313-554-3111
Mailing Address - Fax:313-554-3113
Practice Address - Street 1:570 CLINTON ST
Practice Address - Street 2:WAYNE COUNTY JAIL-DIVISION 1
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-2334
Practice Address - Country:US
Practice Address - Phone:313-554-3111
Practice Address - Fax:313-554-3113
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI821292171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator