Individual
MRS. DANIELLE E SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
161 W WISCONSIN AVE STE 2B, PEWAUKEE, WI 53072-3468
(262) 695-8857
(262) 695-8879
Mailing address
W243N5807 QUAIL RUN LN, SUSSEX, WI 53089-3680
(262) 695-8857
(262) 695-8879
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2476-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
392929500010
BCBS
WI
05
—
40906600
—
WI
Enumeration date
06/20/2006
Last updated
07/08/2007
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