Provider Demographics
NPI:1033245758
Name:DONESKI, ROBERT CHRISTIAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHRISTIAN
Last Name:DONESKI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 S CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7432
Mailing Address - Country:US
Mailing Address - Phone:417-840-4391
Mailing Address - Fax:
Practice Address - Street 1:SPRINGFIELD PUBLIC SCHOOLS
Practice Address - Street 2:1610 E SUNSHINE ST.
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-840-4391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009003095103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2140Medicare PIN
MOMA2140002Medicare PIN
140520003Medicare PIN
142260003Medicare PIN
000022130Medicare PIN