Individual
MRS. SARAH BETH DONOVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1160 KEPLER DR, GREEN BAY, WI 54311
(920) 288-5500
(920) 288-5510
Mailing address
1160 KEPLER DR, GREEN BAY, WI 54311-8321
(920) 288-5500
(920) 288-5510
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CADC-D #13860
WI
101YP2500X
Professional Counselor
Primary
3564-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40997300
MEDICAL ASSISTANCE
WI
Enumeration date
10/12/2006
Last updated
12/09/2021
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