Provider Demographics
NPI:1629006960
Name:DONALDSON, DAVID ROSS (ACSW,LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ROSS
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:ACSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 HINMAN AVE
Mailing Address - Street 2:UNIT 3
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-4613
Mailing Address - Country:US
Mailing Address - Phone:847-491-1663
Mailing Address - Fax:
Practice Address - Street 1:3003 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-2833
Practice Address - Country:US
Practice Address - Phone:773-508-1129
Practice Address - Fax:773-262-7084
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL992161Medicare ID - Type Unspecified