Provider Demographics
NPI:1194758946
Name:PAQUETTE, DANA RENE' (LCP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:RENE'
Last Name:PAQUETTE
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:RENE'
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RMLP
Mailing Address - Street 1:4499 INDIANA RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-9162
Mailing Address - Country:US
Mailing Address - Phone:785-255-4460
Mailing Address - Fax:
Practice Address - Street 1:204 E 15TH ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3903
Practice Address - Country:US
Practice Address - Phone:785-242-2183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical