Provider Demographics
NPI:1194371278
Name:DORN, DANIELLE MARIANNE
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:MARIANNE
Last Name:DORN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:MARIANNE
Other - Last Name:DORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:3620 WINSLOW PL N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8758
Mailing Address - Country:US
Mailing Address - Phone:910-742-5462
Mailing Address - Fax:
Practice Address - Street 1:3620 WINSLOW PL N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8758
Practice Address - Country:US
Practice Address - Phone:206-395-4524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60943247103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical