Provider Demographics
NPI:1073371985
Name:DONEGON, MCKENNA ANN
Entity Type:Individual
Prefix:
First Name:MCKENNA
Middle Name:ANN
Last Name:DONEGON
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 1:17281 W MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2764
Mailing Address - Country:US
Mailing Address - Phone:920-214-3032
Mailing Address - Fax:
Practice Address - Street 1:17281 W MAPLE LN
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2764
Practice Address - Country:US
Practice Address - Phone:920-214-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056011307225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty