Provider Demographics
NPI:1609455419
Name:BARTLETT, DANIELLE IPPOLITO
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:IPPOLITO
Last Name:BARTLETT
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 1:139 SAINT CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AL
Mailing Address - Zip Code:35080-7042
Mailing Address - Country:US
Mailing Address - Phone:205-451-2226
Mailing Address - Fax:
Practice Address - Street 1:1820 SOUTHPARK DR
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2094
Practice Address - Country:US
Practice Address - Phone:205-490-8228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician