Provider Demographics
NPI:1912733239
Name:WHITE, DAISY KAY
Entity type:Individual
Prefix:MISS
First Name:DAISY
Middle Name:KAY
Last Name:WHITE
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 1:2213 E SUMMIT TRL
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:WI
Mailing Address - Zip Code:54836-9515
Mailing Address - Country:US
Mailing Address - Phone:715-817-8752
Mailing Address - Fax:
Practice Address - Street 1:2207 E 5TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880
Practice Address - Country:US
Practice Address - Phone:218-212-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical