Provider Demographics
NPI:1508981564
Name:PITTMAN, DONNA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:PITTMAN
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 1:1210 BERRY LN
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1421
Mailing Address - Country:US
Mailing Address - Phone:708-768-1985
Mailing Address - Fax:888-377-8085
Practice Address - Street 1:7531 S STONY ISLAND AVE
Practice Address - Street 2:SUITE 173
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3954
Practice Address - Country:US
Practice Address - Phone:708-768-1985
Practice Address - Fax:888-377-8085
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical