Provider Demographics
NPI:1952606204
Name:PELZ, DANIELLE N (MS, BCBA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:N
Last Name:PELZ
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12022 REDDING DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9777
Mailing Address - Country:US
Mailing Address - Phone:410-688-9989
Mailing Address - Fax:
Practice Address - Street 1:3426 W DELPHI PIKE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-9266
Practice Address - Country:US
Practice Address - Phone:410-688-9989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-9420103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst