Provider Demographics
NPI:1699783175
Name:MEYER, DONALD JOHN (PHD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:JOHN
Last Name:MEYER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-0364
Mailing Address - Country:US
Mailing Address - Phone:920-261-4100
Mailing Address - Fax:920-261-8801
Practice Address - Street 1:1315 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094
Practice Address - Country:US
Practice Address - Phone:920-261-4100
Practice Address - Fax:920-261-8801
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1365057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11258OtherDEAN HEALTH
WI39184249602OtherUNITY INS LAKE MILLS
6115476OtherUNITED BEHAVIORAL HEALTH
WI180396OtherMHN INSURANCE
WI39184249601OtherUNITY INSURANCE WATERTOWN
WI1011266OtherPHYSICIANS PLUS
WI39079000Medicaid
39184249603OtherJOHN DEERE HEALTH
39184249603OtherJOHN DEERE HEALTH