1558739581 NPI number — DR. DANIELLE GODFREDSEN PSY.D.

Table of content: DR. DANIELLE GODFREDSEN PSY.D. (NPI 1558739581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558739581 NPI number — DR. DANIELLE GODFREDSEN PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GODFREDSEN
Provider First Name:
DANIELLE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GODFREDSEN
Provider Other First Name:
DANI
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1558739581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10439 S 51ST ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85044-5222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-243-2973
Provider Business Mailing Address Fax Number:
480-635-9987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10439 S 51ST ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85044-5222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-243-2973
Provider Business Practice Location Address Fax Number:
480-635-9987
Provider Enumeration Date:
09/08/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  4660 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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