Provider Demographics
NPI:1689004830
Name:DONATH-SKEEN, BREYAN
Entity Type:Individual
Prefix:
First Name:BREYAN
Middle Name:
Last Name:DONATH-SKEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 VERNON DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5374
Mailing Address - Country:US
Mailing Address - Phone:920-272-1200
Mailing Address - Fax:
Practice Address - Street 1:2680 VERNON DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5374
Practice Address - Country:US
Practice Address - Phone:920-272-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-24
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8088-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical