Provider Demographics
NPI:1871000984
Name:GERMAN, DANELLE MARIE
Entity Type:Individual
Prefix:
First Name:DANELLE
Middle Name:MARIE
Last Name:GERMAN
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:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:MINERAL CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44656-0096
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1433 FIFTH ST NW
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-2030
Practice Address - Country:US
Practice Address - Phone:330-343-8171
Practice Address - Fax:330-343-8439
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCII.161588101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0288949Medicaid