Basic Information
| Provider Information | |||||||||
| NPI: | 1013271907 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLACKWELL | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LSWAIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5127 | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982065127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253395453 | ||||||||
| FaxNumber: | 4252524441 | ||||||||
| Practice Location | |||||||||
| Address1: | 1728 W MARINE VIEW DR STE 106 | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982012094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253395453 | ||||||||
| FaxNumber: | 4252524441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2012 | ||||||||
| LastUpdateDate: | 09/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | SC6097550 | WA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | LW60827685 | WA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.