Provider Demographics
NPI:1093932295
Name:WASSON, DONNA SUE (MA, LCPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:SUE
Last Name:WASSON
Suffix:
Gender:F
Credentials:MA, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 W HAYMEADOW LN
Mailing Address - Street 2:APT 2B
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-3130
Mailing Address - Country:US
Mailing Address - Phone:309-883-2547
Mailing Address - Fax:
Practice Address - Street 1:6615 N BIG HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2450
Practice Address - Country:US
Practice Address - Phone:309-692-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional