Provider Demographics
NPI:1245516186
Name:DYER, DANIELLE L
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:L
Last Name:DYER
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 1578
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-1578
Mailing Address - Country:US
Mailing Address - Phone:458-205-9450
Mailing Address - Fax:
Practice Address - Street 1:5164 DEER HARBOR RD
Practice Address - Street 2:
Practice Address - City:DEER HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98243
Practice Address - Country:US
Practice Address - Phone:541-686-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health