Provider Demographics
NPI:1215200225
Name:DANIEL-WAY, LISA M (MA, BCBA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:DANIEL-WAY
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15284 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-7867
Mailing Address - Country:US
Mailing Address - Phone:515-601-5336
Mailing Address - Fax:
Practice Address - Street 1:15284 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7867
Practice Address - Country:US
Practice Address - Phone:515-601-5336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-8318103K00000X
IA095922103K00000X
CT1871103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst