Provider Demographics
NPI:1457115990
Name:SMALLWOOD, DANIELLE J (PSS)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:J
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 MONMOUTH ST APT 13
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97351-1010
Mailing Address - Country:US
Mailing Address - Phone:971-701-0522
Mailing Address - Fax:
Practice Address - Street 1:945 SE UGLOW AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-2642
Practice Address - Country:US
Practice Address - Phone:503-837-1762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000110313175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty