Provider Demographics
NPI:1982171369
Name:DONNELLY, CATHERINE A (JD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:JD
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 594
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:OR
Mailing Address - Zip Code:97048-0594
Mailing Address - Country:US
Mailing Address - Phone:913-208-5401
Mailing Address - Fax:
Practice Address - Street 1:547 E 2ND ST APT 1
Practice Address - Street 2:
Practice Address - City:RAINIER
Practice Address - State:OR
Practice Address - Zip Code:97048-2837
Practice Address - Country:US
Practice Address - Phone:913-208-5401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst