Provider Demographics
NPI:1053591354
Name:DONAHOO, SUSAN EILEEN (PSYD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:EILEEN
Last Name:DONAHOO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 W. RAND RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3985
Mailing Address - Country:US
Mailing Address - Phone:847-259-8583
Mailing Address - Fax:
Practice Address - Street 1:660 WOELFEL RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2927
Practice Address - Country:US
Practice Address - Phone:262-789-8089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2665-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1053591354OtherNPI
WI000173206Medicare PIN