Provider Demographics
NPI:1023636065
Name:VANCE, DANIELLE (MT-BC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:VANCE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 WAGNER DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WI
Mailing Address - Zip Code:53525-9132
Mailing Address - Country:US
Mailing Address - Phone:608-289-0951
Mailing Address - Fax:
Practice Address - Street 1:208 S CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-2733
Practice Address - Country:US
Practice Address - Phone:715-212-5086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
15899225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist