Provider Demographics
NPI:1447139621
Name:RUPNOW, DANIELLE M (MSED, BC, OWNER)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:RUPNOW
Suffix:
Gender:F
Credentials:MSED, BC, OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 KIMBERLITE PL
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-5225
Mailing Address - Country:US
Mailing Address - Phone:260-479-7712
Mailing Address - Fax:
Practice Address - Street 1:1922 KIMBERLITE PL
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5225
Practice Address - Country:US
Practice Address - Phone:260-479-7712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000772251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health