Individual
MR. EDWARD J DONNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3601 30TH AVE, SUITE LL1, KENOSHA, WI 53144-1695
(262) 657-9777
(262) 657-9785
Mailing address
3601 30TH AVE, SUITE LL1, KENOSHA, WI 53144-1695
(262) 657-9777
(262) 657-9785
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2142057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39755100
—
WI
Enumeration date
05/10/2006
Last updated
10/06/2007
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