Individual provider Active NPI

Danielle M Diedrich, LCSW

  • Clinical Social Worker
  • Appleton, WI
National Provider Identifier
1790408326
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
11847-123
Practice address
320 S Walnut St
Appleton, WI 54911-5918
Phone
(920) 832-5270
Fax
(920) 832-4767
NPI assigned
Sep 20, 2022
Last updated
Sep 27, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 132561-121 WI
Clinical Social Worker 1041C0700X 11847-123 Primary

Addresses

Primary practice location

320 S Walnut St
Appleton, WI 54911-5918

Mailing address

320 S Walnut St
Appleton, WI 54911-5918
Phone (920) 832-5270

Other identifiers 1

IdentifierTypeStateIssuer
100214934MedicaidWI

Other names 1

  • Danielle M Rausch Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
132561-121WIMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
County of Outagamie CurrentSince Jun 14, 2024 Accepting new patients

Locations

320 S Walnut St
Appleton, WI 54911
Phone (920) 832-1624

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1790408326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 S WALNUT ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549115918",
            "telephone_number": "920-832-5270",
            "fax_number": "920-832-4767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 S WALNUT ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549115918",
            "telephone_number": "920-832-5270",
            "fax_number": "920-832-4767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIEDRICH",
        "first_name": "DANIELLE",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-20",
        "last_updated": "2024-09-27",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "132561-121",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": "11847-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100214934",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DANIELLE",
            "last_name": "RAUSCH",
            "middle_name": "M",
            "credential": "CSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.