Provider Demographics
NPI:1346309457
Name:RONAN, DONNA MARY (PHD)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARY
Last Name:RONAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W BROADWAY ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2494
Mailing Address - Country:US
Mailing Address - Phone:989-779-8999
Mailing Address - Fax:989-779-2219
Practice Address - Street 1:311 W BROADWAY ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2494
Practice Address - Country:US
Practice Address - Phone:989-779-8999
Practice Address - Fax:989-779-2219
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008543103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical