Provider Demographics
NPI:1184175515
Name:OLDER, DANIELLE (LISW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:OLDER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12683 ISLANDVIEW AVE NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-9157
Mailing Address - Country:US
Mailing Address - Phone:330-931-1244
Mailing Address - Fax:
Practice Address - Street 1:12683 ISLANDVIEW AVE NW
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-9157
Practice Address - Country:US
Practice Address - Phone:330-931-1244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.20020681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical