Provider Demographics
NPI:1225824899
Name:EARIXSON, DANIEL QUINN (PHD, LP)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:QUINN
Last Name:EARIXSON
Suffix:
Gender:
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MANOMIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-2607
Mailing Address - Country:US
Mailing Address - Phone:651-323-7660
Mailing Address - Fax:
Practice Address - Street 1:701 MANOMIN AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-2607
Practice Address - Country:US
Practice Address - Phone:651-323-7660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP7123103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist