Provider Demographics
NPI:1063948974
Name:DONALDOSN, CHARLES W
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:DONALDOSN
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 1:1946 N 13TH ST STE 230
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7200
Mailing Address - Country:US
Mailing Address - Phone:419-244-8624
Mailing Address - Fax:
Practice Address - Street 1:1946 N 13TH ST STE 230
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-7200
Practice Address - Country:US
Practice Address - Phone:419-244-8624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI1581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical