Individual
MRS. DONNA TINA MAY GLISSENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW, CSAC
Contact information
Practice address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-4200
(920) 926-8933
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-4200
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15953-132
WI
1041C0700X
Clinical Social Worker
Primary
9255-123
WI
Other
Enumeration date
03/01/2013
Last updated
12/03/2020
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