Provider Demographics
NPI:1831529965
Name:TUDISCO DONAR, MARIA SOL (MASTERS DEGREE IN PS)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:SOL
Last Name:TUDISCO DONAR
Suffix:
Gender:F
Credentials:MASTERS DEGREE IN PS
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:SOL
Other - Last Name:TUDISCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASTERS DEGREE IN PS
Mailing Address - Street 1:PO BOX 36 1155 N. ELM ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-1207
Mailing Address - Country:US
Mailing Address - Phone:608-348-4060
Mailing Address - Fax:608-348-4191
Practice Address - Street 1:1155 N. ELM ST
Practice Address - Street 2:SUITE 120
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-1207
Practice Address - Country:US
Practice Address - Phone:608-348-4060
Practice Address - Fax:608-348-4191
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1899-226101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor