Provider Demographics
NPI:1710193735
Name:DONEGAN, MELISSA MAY
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MAY
Last Name:DONEGAN
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 1:2247 HILLVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MOUNDS VIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1225
Mailing Address - Country:US
Mailing Address - Phone:612-871-3320
Mailing Address - Fax:
Practice Address - Street 1:2419 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3450
Practice Address - Country:US
Practice Address - Phone:612-871-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN169559101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN169559OtherIAPSRS