Provider Demographics
NPI:1396025417
Name:DONNER, CYNTHIA JO (MS, LPC, SAC-IT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JO
Last Name:DONNER
Suffix:
Gender:F
Credentials:MS, LPC, SAC-IT
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:JO
Other - Last Name:PLOUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC, SAC-IT
Mailing Address - Street 1:10045 W LISBON AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2446
Mailing Address - Country:US
Mailing Address - Phone:414-358-7999
Mailing Address - Fax:414-358-7158
Practice Address - Street 1:10045 W LISBON AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-2446
Practice Address - Country:US
Practice Address - Phone:414-358-7999
Practice Address - Fax:414-358-7158
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15955130101YA0400X
WI4896-125101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1396025417Medicaid