Provider Demographics
NPI:1184846727
Name:FLANAGAN, DONNAMARIE MARIE (DONNA MARIE FLANAGAN)
Entity Type:Individual
Prefix:
First Name:DONNAMARIE
Middle Name:MARIE
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:DONNA MARIE FLANAGAN
Other - Prefix:
Other - First Name:DONNAMARIE
Other - Middle Name:
Other - Last Name:FLANAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DONNAMARIE FLANAGAN
Mailing Address - Street 1:420 COLUMBIA ST.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47901
Mailing Address - Country:US
Mailing Address - Phone:765-420-1621
Mailing Address - Fax:
Practice Address - Street 1:420 COLUMBIA ST
Practice Address - Street 2:SUITE 205
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901
Practice Address - Country:US
Practice Address - Phone:765-420-1621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001137A1041C0700X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical