Provider Demographics
NPI:1558538769
Name:WANNER, DANENE R
Entity Type:Individual
Prefix:
First Name:DANENE
Middle Name:R
Last Name:WANNER
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 1:921 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2257
Mailing Address - Country:US
Mailing Address - Phone:541-686-6000
Mailing Address - Fax:541-344-8239
Practice Address - Street 1:921 COUNTRY CLUB RD
Practice Address - Street 2:222
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2257
Practice Address - Country:US
Practice Address - Phone:541-686-6000
Practice Address - Fax:541-344-8239
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORL52611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health