Provider Demographics
NPI:1205690641
Name:DU, HONGDA
Entity type:Individual
Prefix:
First Name:HONGDA
Middle Name:
Last Name:DU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3936
Mailing Address - Country:US
Mailing Address - Phone:920-840-1569
Mailing Address - Fax:
Practice Address - Street 1:1306 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902
Practice Address - Country:US
Practice Address - Phone:920-808-9505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1192-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst