Provider Demographics
NPI:1285273441
Name:DOONAN, ASHLEE MARIE
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:MARIE
Last Name:DOONAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:VIOLA
Mailing Address - State:IL
Mailing Address - Zip Code:61486-9443
Mailing Address - Country:US
Mailing Address - Phone:309-236-4653
Mailing Address - Fax:
Practice Address - Street 1:1401 8TH AVE
Practice Address - Street 2:
Practice Address - City:VIOLA
Practice Address - State:IL
Practice Address - Zip Code:61486-9443
Practice Address - Country:US
Practice Address - Phone:309-236-4653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-04
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490213601041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool