Provider Demographics
NPI:1568948974
Name:STEWART-MARTIN, DONNA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:STEWART-MARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 SCIENCE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1097
Mailing Address - Country:US
Mailing Address - Phone:608-236-1903
Mailing Address - Fax:
Practice Address - Street 1:303 S PATERSON ST STE 1A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-4534
Practice Address - Country:US
Practice Address - Phone:608-405-5111
Practice Address - Fax:608-554-1052
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4714-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional