Provider Demographics
NPI:1508192865
Name:DANIELSON, KELLY MARIE (MSW)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MARIE
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48585 HAYES RD.
Mailing Address - Street 2:CROSSING PATHS
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315
Mailing Address - Country:US
Mailing Address - Phone:586-884-4714
Mailing Address - Fax:586-884-4693
Practice Address - Street 1:48585 HAYES RD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-4402
Practice Address - Country:US
Practice Address - Phone:586-884-4714
Practice Address - Fax:586-884-4693
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010912621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical