Provider Demographics
NPI:1528345097
Name:KONDZIOLKA, DANIELLE NORBY (LICSW)
Entity type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:NORBY
Last Name:KONDZIOLKA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:CHRISTINE
Other - Last Name:LIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:605-328-6512
Practice Address - Street 1:1705 ANNE ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-6151
Practice Address - Country:US
Practice Address - Phone:218-333-5000
Practice Address - Fax:218-333-5880
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN204541041C0700X
MN02454104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN800003200OtherPTAN