Provider Demographics
NPI:1659036416
Name:SIMONSON, DANIEL (MS, LP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SIMONSON
Suffix:
Gender:M
Credentials:MS, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10026 UNIVERSITY AVE NW STE 215
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-2215
Mailing Address - Country:US
Mailing Address - Phone:763-639-7462
Mailing Address - Fax:
Practice Address - Street 1:10026 UNIVERSITY AVE NW STE 215
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-2215
Practice Address - Country:US
Practice Address - Phone:763-639-7462
Practice Address - Fax:952-487-5234
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist