Provider Demographics
NPI:1659455038
Name:JARAMILLO, DANIELA A (PSY D)
Entity type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:A
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 N BAYSHORE DRIVE
Mailing Address - Street 2:A250
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4536
Mailing Address - Country:US
Mailing Address - Phone:414-962-6764
Mailing Address - Fax:414-962-6765
Practice Address - Street 1:5800 N BAYSHORE DRIVE
Practice Address - Street 2:A250
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4536
Practice Address - Country:US
Practice Address - Phone:414-962-6764
Practice Address - Fax:414-962-6765
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2305103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39770600Medicaid