Basic Information
| Provider Information | |||||||||
| NPI: | 1790918332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAILEY | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | M | ||||||||
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| OtherOrganizationType: | |||||||||
| OtherLastName: | MUTERSPAW | ||||||||
| OtherFirstName: | DANIELLE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 SHAWNEE RD | ||||||||
| Address2: | |||||||||
| City: | CRIDERSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458062240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199992010 | ||||||||
| FaxNumber: | 4199996284 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 S GLENN AVE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON COURT HOUSE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431601712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403356391 | ||||||||
| FaxNumber: | 7403353531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2009 | ||||||||
| LastUpdateDate: | 12/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 104100000X | S.1000076 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.