Provider Demographics
NPI:1942534417
Name:DELLER, DANIELLE JEAN (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:JEAN
Last Name:DELLER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-9397
Mailing Address - Country:US
Mailing Address - Phone:414-847-5722
Mailing Address - Fax:414-433-5722
Practice Address - Street 1:1575 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-9397
Practice Address - Country:US
Practice Address - Phone:414-847-5722
Practice Address - Fax:414-433-5722
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100054043Medicaid