Provider Demographics
NPI:1255869376
Name:DONOHUE, DELANEY KYL (MT-BC)
Entity Type:Individual
Prefix:
First Name:DELANEY
Middle Name:KYL
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15400 18TH AVE N APT 1206
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-2480
Mailing Address - Country:US
Mailing Address - Phone:563-580-3790
Mailing Address - Fax:
Practice Address - Street 1:15400 18TH AVE N APT 1206
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-2480
Practice Address - Country:US
Practice Address - Phone:563-580-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist