Provider Demographics
NPI:1619256179
Name:POLLEX-RABL, DANIELLE RAE (MSSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RAE
Last Name:POLLEX-RABL
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 WINNEBAGO AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-1230
Mailing Address - Country:US
Mailing Address - Phone:608-745-0141
Mailing Address - Fax:608-745-4990
Practice Address - Street 1:2910 NEW PINERY RD
Practice Address - Street 2:UNIT A2
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-9292
Practice Address - Country:US
Practice Address - Phone:608-745-4900
Practice Address - Fax:608-745-4990
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30161231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical