Provider Demographics
NPI:1508362815
Name:DONOVAN, ANN MARIE (BCBA, MSC)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:BCBA, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1156
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72078-1156
Mailing Address - Country:US
Mailing Address - Phone:256-651-1500
Mailing Address - Fax:
Practice Address - Street 1:105 MISSOURI CIR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-1131
Practice Address - Country:US
Practice Address - Phone:256-651-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-277103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst