Provider Demographics
NPI:1174702328
Name:DONALDSON, WILLIAM W
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:W
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4503 W DEYOUNG ST
Mailing Address - Street 2:SUITE 103C
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-7654
Mailing Address - Country:US
Mailing Address - Phone:618-998-0888
Mailing Address - Fax:618-993-1808
Practice Address - Street 1:4503 W DEYOUNG ST
Practice Address - Street 2:SUITE 103C
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-7654
Practice Address - Country:US
Practice Address - Phone:618-998-0888
Practice Address - Fax:618-993-1808
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical