Provider Demographics
NPI:1659795003
Name:WILLMAN, DANIEL M (MS, LMFT, SAC-IT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:M
Last Name:WILLMAN
Suffix:
Gender:M
Credentials:MS, LMFT, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 67TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-3836
Mailing Address - Country:US
Mailing Address - Phone:262-652-9830
Mailing Address - Fax:
Practice Address - Street 1:4109 67TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-3836
Practice Address - Country:US
Practice Address - Phone:262-652-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1064-124106H00000X
WI17046-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)