Provider Demographics
NPI:1720589096
Name:LINDBERG, DANIELLE (LCSW, LICSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 3RD AVE S STE 204
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1865
Mailing Address - Country:US
Mailing Address - Phone:701-543-5836
Mailing Address - Fax:
Practice Address - Street 1:808 3RD AVE S STE 204
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1865
Practice Address - Country:US
Practice Address - Phone:701-543-5836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5978104100000X, 1041C0700X
MN302931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker