Provider Demographics
NPI:1508582776
Name:DONAGHY, ELISE WOJEWODA (PHD)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:WOJEWODA
Last Name:DONAGHY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:ANN
Other - Last Name:WOJEWODA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2111 TIBBITS CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1166
Mailing Address - Country:US
Mailing Address - Phone:253-325-3047
Mailing Address - Fax:
Practice Address - Street 1:500 E WASHINGTON ST STE 100
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2057
Practice Address - Country:US
Practice Address - Phone:734-615-7853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301019136103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist