Provider Demographics
NPI:1699182964
Name:PATTERSON, DANIELLE MARIE
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:MARIE
Last Name:PATTERSON
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 1:3823 MESA GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-2821
Mailing Address - Country:US
Mailing Address - Phone:719-300-5735
Mailing Address - Fax:719-931-5603
Practice Address - Street 1:1870 DUBLIN BLVD
Practice Address - Street 2:STE B
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1264
Practice Address - Country:US
Practice Address - Phone:719-300-5735
Practice Address - Fax:719-931-5603
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00099222121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000154160Medicaid