Provider Demographics
NPI:1467985408
Name:EAGAN, DANIELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:EAGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:FLATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 W THOMAS RD STE 315
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4422
Mailing Address - Country:US
Mailing Address - Phone:602-406-3671
Mailing Address - Fax:602-406-6115
Practice Address - Street 1:222 W THOMAS RD STE 315
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013
Practice Address - Country:US
Practice Address - Phone:602-406-3671
Practice Address - Fax:602-406-6115
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
AZ4854103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist