Provider Demographics
NPI:1649794173
Name:SODERGREN, DANIELLE L (LMHC, IAADC, RPT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:L
Last Name:SODERGREN
Suffix:
Gender:F
Credentials:LMHC, IAADC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 INGERSOLL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-3920
Mailing Address - Country:US
Mailing Address - Phone:760-828-5477
Mailing Address - Fax:
Practice Address - Street 1:3209 INGERSOLL AVE STE 100
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-3920
Practice Address - Country:US
Practice Address - Phone:760-828-5477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087173101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health