Provider Demographics
NPI:1902956220
Name:STODDARD, DANIELLE G (LCPC)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:G
Last Name:STODDARD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:304 N MILWAUKEE ST
Mailing Address - City:MARK
Mailing Address - State:IL
Mailing Address - Zip Code:61340-0185
Mailing Address - Country:US
Mailing Address - Phone:309-830-1096
Mailing Address - Fax:
Practice Address - Street 1:2428 CHARTRES ST
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:IL
Practice Address - Zip Code:61301-1107
Practice Address - Country:US
Practice Address - Phone:815-780-8765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-006374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health