Provider Demographics
NPI:1346394525
Name:CONN, DANIELLE RENEE
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:RENEE
Last Name:CONN
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 1:260 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5007
Mailing Address - Country:US
Mailing Address - Phone:805-785-0874
Mailing Address - Fax:
Practice Address - Street 1:277 SOUTH ST STE Y
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-5039
Practice Address - Country:US
Practice Address - Phone:805-489-9659
Practice Address - Fax:805-489-9659
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1199Medicare ID - Type UnspecifiedDOCUMENTATION