Provider Demographics
NPI:1366637126
Name:BACIC, DONNA MARIE (LSCSW)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIE
Last Name:BACIC
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10965 GRANADA LN
Mailing Address - Street 2:#103
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1401
Mailing Address - Country:US
Mailing Address - Phone:913-345-1880
Mailing Address - Fax:913-491-4788
Practice Address - Street 1:10965 GRANADA LN
Practice Address - Street 2:#103
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1401
Practice Address - Country:US
Practice Address - Phone:913-345-1880
Practice Address - Fax:913-491-4788
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2018174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist