Provider Demographics
NPI:1780179184
Name:DANIELSON, RICOH
Entity type:Individual
Prefix:
First Name:RICOH
Middle Name:
Last Name:DANIELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18525 N SCOTTSDALE RD UNIT 3022
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-9685
Mailing Address - Country:US
Mailing Address - Phone:480-747-5970
Mailing Address - Fax:
Practice Address - Street 1:18525 N SCOTTSDALE RD UNIT 3022
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-9685
Practice Address - Country:US
Practice Address - Phone:480-747-5970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ$$$$$$$$$Medicaid