Provider Demographics
NPI:1972931483
Name:YENDERUSIAK, DONNA RAE (LPCC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:RAE
Last Name:YENDERUSIAK
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:RAE
Other - Last Name:HOYLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 715194
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-5194
Mailing Address - Country:US
Mailing Address - Phone:614-355-8004
Mailing Address - Fax:614-355-2220
Practice Address - Street 1:495 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5349
Practice Address - Country:US
Practice Address - Phone:614-355-8007
Practice Address - Fax:614-355-8620
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1000333101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846675Medicaid