Provider Demographics
NPI:1548214802
Name:DONOVAN, NANCY (MSSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1405
Mailing Address - Country:US
Mailing Address - Phone:715-386-3418
Mailing Address - Fax:
Practice Address - Street 1:5445 MINNEHAHA AVE
Practice Address - Street 2:BUILDING 9
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2330
Practice Address - Country:US
Practice Address - Phone:612-467-4294
Practice Address - Fax:612-725-2053
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN66781041C0700X
WI1184 - 1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical