Provider Demographics
NPI:1265783427
Name:YELVINGTON, DONNA (SAC-IT, PC-TL)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:YELVINGTON
Suffix:
Gender:F
Credentials:SAC-IT, PC-TL
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 240542
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-9017
Mailing Address - Country:US
Mailing Address - Phone:920-905-0922
Mailing Address - Fax:
Practice Address - Street 1:4550 W BRADLEY ROAD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53223
Practice Address - Country:US
Practice Address - Phone:414-371-1600
Practice Address - Fax:414-371-2400
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16704-130101YA0400X
WI1610-226101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional