Provider Demographics
NPI:1447421060
Name:DONNELL, CATHY JO STRADER (PHD)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:JO STRADER
Last Name:DONNELL
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 1:1914 SCOTTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4509
Mailing Address - Country:US
Mailing Address - Phone:734-476-0478
Mailing Address - Fax:
Practice Address - Street 1:1914 SCOTTWOOD AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4509
Practice Address - Country:US
Practice Address - Phone:734-476-0478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-23
Last Update Date:2008-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL 932585103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical