Basic Information
| Provider Information | |||||||||
| NPI: | 1710048350 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KONKEL | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | LPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 E 3RD ST | ||||||||
| Address2: | 201 | ||||||||
| City: | WINONA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559873478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5074527292 | ||||||||
| FaxNumber: | 5074579887 | ||||||||
| Practice Location | |||||||||
| Address1: | 66 E 3RD ST | ||||||||
| Address2: | 201 | ||||||||
| City: | WINONA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559873478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5074527292 | ||||||||
| FaxNumber: | 5074579887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | LPP 0119 | MN | X | Behavioral Health & Social Service Providers | Psychologist | Clinical | 101YP2500X | 00436 | MN | X | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | HP77414 | 01 | MN | HEALTHPARTNERS | OTHER |