Provider Demographics
NPI:1457740003
Name:JILL A DONELAN
Entity Type:Organization
Organization Name:JILL A DONELAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DONELAN
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LPC-MH, QMHP
Authorized Official - Phone:605-480-3683
Mailing Address - Street 1:1711 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-6735
Mailing Address - Country:US
Mailing Address - Phone:605-480-3683
Mailing Address - Fax:
Practice Address - Street 1:1711 SUNRISE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-6735
Practice Address - Country:US
Practice Address - Phone:605-480-3683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPCMH2241251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health