Provider Demographics
NPI:1134811326
Name:MCCHESNEY, DANIEL J
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:MCCHESNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 HASKIN DR
Mailing Address - Street 2:
Mailing Address - City:PARDEEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53954-9224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 HASKIN DR
Practice Address - Street 2:
Practice Address - City:PARDEEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53954-9224
Practice Address - Country:US
Practice Address - Phone:608-617-3698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251S00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No251S00000XAgenciesCommunity/Behavioral Health