Provider Demographics
NPI:1033830989
Name:DWYER, DANIELLE LYNN (PHD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LYNN
Last Name:DWYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:LYNN
Other - Last Name:HAGGERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2222 CHERRY ST STE 1900
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2673
Mailing Address - Country:US
Mailing Address - Phone:419-251-3878
Mailing Address - Fax:
Practice Address - Street 1:3020 N MCCORD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1702
Practice Address - Country:US
Practice Address - Phone:419-517-7658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301019069103TC2200X
OHP.08461103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0027878Medicaid