Provider Demographics
NPI:1639525421
Name:WITON, DANIELLE (SAC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:WITON
Suffix:
Gender:F
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 N JOHN ST
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:WI
Mailing Address - Zip Code:54136-1841
Mailing Address - Country:US
Mailing Address - Phone:920-733-4443
Mailing Address - Fax:
Practice Address - Street 1:3301 N BALLARD RD
Practice Address - Street 2:SUITE B
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-8928
Practice Address - Country:US
Practice Address - Phone:920-722-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16014101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)