Provider Demographics
NPI:1649800533
Name:MONDLOCH, DANIELLE RACHEL (LCSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RACHEL
Last Name:MONDLOCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DANI
Other - Middle Name:RACHEL
Other - Last Name:MONDLOCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3909 GALLANT FOX DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-4831
Mailing Address - Country:US
Mailing Address - Phone:573-855-7103
Mailing Address - Fax:
Practice Address - Street 1:3501 BERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6584
Practice Address - Country:US
Practice Address - Phone:844-853-8937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180260611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical