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Individual

DANNY PAUL PORTER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LICSW

Contact information

Practice address
762 MEYER ST N, MAPLEWOOD, MN 55119-3861
(612) 998-3387
Mailing address
762 MEYER ST N, MAPLEWOOD, MN 55119-3861
(612) 998-3387

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
12179
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
12179
MN
Enumeration date
05/27/2021
Last updated
05/27/2021
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