Provider Demographics
NPI:1922776665
Name:CAMPBELL, DANIELLE (SWLC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 S 5TH ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-2215
Mailing Address - Country:US
Mailing Address - Phone:406-360-6164
Mailing Address - Fax:
Practice Address - Street 1:445 S 5TH ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2619
Practice Address - Country:US
Practice Address - Phone:406-282-1341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-493351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical