Provider Demographics
NPI:1649978750
Name:LAUTZENHEISER, DR. DANIELLE MARIE (PHD HIC)
Entity type:Individual
Prefix:DR
First Name:DR. DANIELLE
Middle Name:MARIE
Last Name:LAUTZENHEISER
Suffix:
Gender:F
Credentials:PHD HIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3981 EDGEWATER CT STE J
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-7174
Mailing Address - Country:US
Mailing Address - Phone:614-625-5911
Mailing Address - Fax:614-543-1425
Practice Address - Street 1:8017 CRANES CROSSING DR
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-8633
Practice Address - Country:US
Practice Address - Phone:614-625-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YP1600X, 173C00000X, 261Q00000X
171100000X
NY171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturist
No171400000XOther Service ProvidersHealth & Wellness Coach
No173C00000XOther Service ProvidersReflexologist