Provider Demographics
NPI:1962626788
Name:SHIMECK, DONNA MAE (MA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MAE
Last Name:SHIMECK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-0897
Mailing Address - Country:US
Mailing Address - Phone:715-369-2215
Mailing Address - Fax:715-369-2214
Practice Address - Street 1:705 E TIMBER DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-2859
Practice Address - Country:US
Practice Address - Phone:715-369-2215
Practice Address - Fax:715-369-2214
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2752-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39659000Medicaid