Provider Demographics
NPI:1306555487
Name:MONSERUD, DANIEL L (LICSW)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:L
Last Name:MONSERUD
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 17TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SOUTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-1835
Mailing Address - Country:US
Mailing Address - Phone:612-407-8072
Mailing Address - Fax:
Practice Address - Street 1:409 17TH AVE N
Practice Address - Street 2:
Practice Address - City:SOUTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55075-1835
Practice Address - Country:US
Practice Address - Phone:612-407-8072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN16355101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health