Provider Demographics
NPI:1073557716
Name:FERGUSON, DONALD D (PHD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:D
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 KIMBALL LN STE 206
Mailing Address - Street 2:INFINITE RELATIONSHIPS, LLC
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-1786
Mailing Address - Country:US
Mailing Address - Phone:608-848-8000
Mailing Address - Fax:
Practice Address - Street 1:951 KIMBALL LN STE 206
Practice Address - Street 2:INFINITE RELATIONSHIPS, LLC
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1786
Practice Address - Country:US
Practice Address - Phone:608-848-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1376-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39086600Medicaid
R60516Medicare UPIN
WI39086600Medicaid
WI220018790Medicare PIN