Provider Demographics
NPI:1316179682
Name:DANIEL, JANET L (MS)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:DANIEL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E DUPONT ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835
Mailing Address - Country:US
Mailing Address - Phone:260-490-8110
Mailing Address - Fax:260-490-7707
Practice Address - Street 1:310 E DUPONT ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835
Practice Address - Country:US
Practice Address - Phone:260-490-8110
Practice Address - Fax:260-490-7707
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool