Provider Demographics
NPI:1336544972
Name:QUANDT, DARYA
Entity type:Individual
Prefix:
First Name:DARYA
Middle Name:
Last Name:QUANDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 N PARK DRIVE LN
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-1603
Mailing Address - Country:US
Mailing Address - Phone:920-749-2390
Mailing Address - Fax:920-749-2399
Practice Address - Street 1:2809 N PARK DRIVE LN
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1603
Practice Address - Country:US
Practice Address - Phone:920-749-2390
Practice Address - Fax:920-749-2399
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5221101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor