Basic Information
Provider Information
NPI: 1619099827
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DAVIS
FirstName: DAYNA
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: LICSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: ISAACSON
OtherFirstName: DAYNA
OtherMiddleName: MARIE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: LICSW
OtherLastNameType: 1
Mailing Information
Address1: 2138 150TH LN NW
Address2:  
City: ANDOVER
State: MN
PostalCode: 553042569
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2450 RIVERSIDE AVE
Address2:  
City: MINNEAPOLIS
State: MN
PostalCode: 554541450
CountryCode: US
TelephoneNumber: 6126726000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/06/2007
LastUpdateDate: 08/22/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X9535MNY Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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