Provider Demographics
NPI:1598326118
Name:DANIELSEN, KJERSTI
Entity type:Individual
Prefix:
First Name:KJERSTI
Middle Name:
Last Name:DANIELSEN
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 1:119 N SHIAWASSEE ST
Mailing Address - Street 2:
Mailing Address - City:BANCROFT
Mailing Address - State:MI
Mailing Address - Zip Code:48414-7709
Mailing Address - Country:US
Mailing Address - Phone:517-420-7860
Mailing Address - Fax:
Practice Address - Street 1:411 W LAKE LANSING RD STE B115
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8439
Practice Address - Country:US
Practice Address - Phone:517-420-7860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501014470225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist