Provider Demographics
NPI:1588720759
Name:HANLON, DONNA (LICSW)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:HANLON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 N STEELE ST APT 4
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-8017
Mailing Address - Country:US
Mailing Address - Phone:206-459-1920
Mailing Address - Fax:253-572-2106
Practice Address - Street 1:4109 BRIDGEPORT WAY W STE B
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4328
Practice Address - Country:US
Practice Address - Phone:206-459-1920
Practice Address - Fax:253-572-2106
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00006154101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional