Provider Demographics
NPI:1487962981
Name:GLASER, DONNA L (LPC, LCPC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:GLASER
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:L
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:1311 S MAIN ST # 183
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-2828
Mailing Address - Country:US
Mailing Address - Phone:715-642-1961
Mailing Address - Fax:
Practice Address - Street 1:1701 W ALLEN ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1872
Practice Address - Country:US
Practice Address - Phone:715-642-1961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3160-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1487962981Medicaid
WI3160-125OtherSTATE OF WISCONSIN