Provider Demographics
NPI:1851864029
Name:CHADWICK, DANIEL (MS, LPC, NBCC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CHADWICK
Suffix:
Gender:M
Credentials:MS, LPC, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 N GRAND AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4841
Mailing Address - Country:US
Mailing Address - Phone:262-299-6755
Mailing Address - Fax:
Practice Address - Street 1:2607 N GRANDVIEW BLVD STE 164
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1686
Practice Address - Country:US
Practice Address - Phone:262-299-6755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18517101YA0400X
WI3942-226101YP2500X
WI7748101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional