Provider Demographics
NPI:1396395414
Name:REPTOWSKI, DANIELLE R
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:R
Last Name:REPTOWSKI
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 1:1470 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-3919
Mailing Address - Country:US
Mailing Address - Phone:630-450-5051
Mailing Address - Fax:
Practice Address - Street 1:1470 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-3919
Practice Address - Country:US
Practice Address - Phone:630-450-5051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician