Provider Demographics
NPI:1649306416
Name:STODDARD, DAUN MARIE (BS)
Entity type:Individual
Prefix:MRS
First Name:DAUN
Middle Name:MARIE
Last Name:STODDARD
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 S US HIGHWAY 1
Mailing Address - Street 2:SUITE D4
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-8120
Mailing Address - Country:US
Mailing Address - Phone:177-248-9472
Mailing Address - Fax:177-248-9042
Practice Address - Street 1:2814 S US HIGHWAY 1
Practice Address - Street 2:SUITE D4
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-8120
Practice Address - Country:US
Practice Address - Phone:177-248-9472
Practice Address - Fax:177-248-9042
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker