Provider Demographics
NPI:1477900538
Name:DANIELSON, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:DANIELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 MOON LAKE DR
Mailing Address - Street 2:APT #11
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-2419
Mailing Address - Country:US
Mailing Address - Phone:320-226-6684
Mailing Address - Fax:
Practice Address - Street 1:530 MOON LAKE DR
Practice Address - Street 2:APT #11
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-2419
Practice Address - Country:US
Practice Address - Phone:320-226-6684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer