Provider Demographics
NPI:1093138984
Name:STAGE, DONNA J (BSL)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:STAGE
Suffix:
Gender:F
Credentials:BSL
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:J
Other - Last Name:GUINNIP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSL
Mailing Address - Street 1:2247 MERRICK HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16928
Mailing Address - Country:US
Mailing Address - Phone:814-367-7542
Mailing Address - Fax:
Practice Address - Street 1:2247 MERRICK HILL ROAD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:PA
Practice Address - Zip Code:16928
Practice Address - Country:US
Practice Address - Phone:814-367-7542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000553103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst