Provider Demographics
NPI:1851126775
Name:MOLLENKAMP, DANAE N (MT-BC)
Entity type:Individual
Prefix:
First Name:DANAE
Middle Name:N
Last Name:MOLLENKAMP
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14311 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:MI
Mailing Address - Zip Code:49021-9237
Mailing Address - Country:US
Mailing Address - Phone:920-342-9340
Mailing Address - Fax:
Practice Address - Street 1:14311 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:MI
Practice Address - Zip Code:49021-9237
Practice Address - Country:US
Practice Address - Phone:920-342-9340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist