Provider Demographics
NPI:1629094875
Name:DONA, ELLEN K (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:K
Last Name:DONA
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4828 XERXES AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1816
Mailing Address - Country:US
Mailing Address - Phone:612-922-3698
Mailing Address - Fax:612-922-3698
Practice Address - Street 1:4828 XERXES AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-1816
Practice Address - Country:US
Practice Address - Phone:612-922-3698
Practice Address - Fax:612-922-3698
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4133103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN060K0DOOtherBCBS
MN1020744OtherP1
MN129846OtherUC
MN61-38365OtherUBH
MN26238OtherHP
MN288323600Medicaid
MN680001759Medicare ID - Type Unspecified