Provider Demographics
NPI:1336155001
Name:LOFLAND, DONA GAIL (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:DONA
Middle Name:GAIL
Last Name:LOFLAND
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1384 FOX RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:WI
Mailing Address - Zip Code:54082-2303
Mailing Address - Country:US
Mailing Address - Phone:612-720-9445
Mailing Address - Fax:715-549-6049
Practice Address - Street 1:1384 FOX RIDGE TRL
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:WI
Practice Address - Zip Code:54082-2303
Practice Address - Country:US
Practice Address - Phone:612-720-9445
Practice Address - Fax:952-949-9503
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3092103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN998226400Medicaid