Provider Demographics
NPI:1871603720
Name:COTTON, DANIEL R (MSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:COTTON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6099 MILL BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2864
Mailing Address - Country:US
Mailing Address - Phone:630-240-0147
Mailing Address - Fax:
Practice Address - Street 1:799 ROOSEVELT RD # 3-104A
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5908
Practice Address - Country:US
Practice Address - Phone:630-240-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL223226OtherBLUE CROSS BLUE SHIELD
IL293793OtherMHN
IL691275OtherFIRST HEALTH
IL691275OtherFIRST HEALTH