Provider Demographics
NPI:1396898318
Name:DONESON, STUART LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:LEE
Last Name:DONESON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4562 COMANCHE DR
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2064
Mailing Address - Country:US
Mailing Address - Phone:517-337-8447
Mailing Address - Fax:
Practice Address - Street 1:4572 S HAGADORN RD STE 2H
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5385
Practice Address - Country:US
Practice Address - Phone:517-203-3300
Practice Address - Fax:517-203-3300
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301 005005103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
62 OC34603OtherBLUECROSS BLUE SHIELD PIN
MI0M89660Medicare ID - Type Unspecified