Provider Demographics
NPI:1053574996
Name:DANNER, STEPHANIE (PHD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:DANNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5828 GARDEN HILL LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2558
Mailing Address - Country:US
Mailing Address - Phone:614-905-9192
Mailing Address - Fax:
Practice Address - Street 1:5828 GARDEN HILL LN
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2558
Practice Address - Country:US
Practice Address - Phone:614-905-9192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicaid