Provider Demographics
NPI:1306261532
Name:DESIRE, DANIELLE (LAC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DESIRE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 S WEBSTER ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5356
Mailing Address - Country:US
Mailing Address - Phone:630-355-9498
Mailing Address - Fax:
Practice Address - Street 1:29 S WEBSTER ST
Practice Address - Street 2:SUITE 250
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5356
Practice Address - Country:US
Practice Address - Phone:630-355-9498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001166171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist