Provider Demographics
NPI:1295180081
Name:DANIELSEN, JODI (LMHC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:DANIELSEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5138
Mailing Address - Country:US
Mailing Address - Phone:888-316-3025
Mailing Address - Fax:
Practice Address - Street 1:111 PLAZA CIR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5138
Practice Address - Country:US
Practice Address - Phone:888-316-3025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00830101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional