Provider Demographics
NPI:1043578719
Name:CONRAD, DONNA Z
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:Z
Last Name:CONRAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3977
Mailing Address - Country:US
Mailing Address - Phone:630-682-7400
Mailing Address - Fax:
Practice Address - Street 1:245 W ROOSEVELT RD BLDG 15
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-3739
Practice Address - Country:US
Practice Address - Phone:630-221-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator