Provider Demographics
NPI:1528643020
Name:PICKART, DANIELLE C
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:C
Last Name:PICKART
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 1:1807 N CENTER ST STE 204
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-1005
Mailing Address - Country:US
Mailing Address - Phone:920-887-8751
Mailing Address - Fax:
Practice Address - Street 1:1807 N CENTER ST STE 204
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-1005
Practice Address - Country:US
Practice Address - Phone:920-887-8751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4690-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health