Provider Demographics
NPI:1508604760
Name:DITLOW, DANIEL (CPC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:DITLOW
Suffix:
Gender:M
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 W ST SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-5202
Mailing Address - Country:US
Mailing Address - Phone:564-225-7596
Mailing Address - Fax:
Practice Address - Street 1:6604 MARTIN WAY E
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-5542
Practice Address - Country:US
Practice Address - Phone:360-639-7002
Practice Address - Fax:360-639-0920
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No175T00000XOther Service ProvidersPeer Specialist