Provider Demographics
NPI:1558350306
Name:HUNTER, DONNA M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:HUNTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 GARRETT ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-4374
Mailing Address - Country:US
Mailing Address - Phone:479-206-3627
Mailing Address - Fax:
Practice Address - Street 1:1993 E 8TH N
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-2326
Practice Address - Country:US
Practice Address - Phone:479-206-3627
Practice Address - Fax:866-584-0449
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00033091041C0700X
AR2505-C1041C0700X
IDLCSW-383741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6207Medicare ID - Type UnspecifiedMEDICARE