Basic Information
| Provider Information | |||||||||
| NPI: | 1487303905 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DONNY | ||||||||
| FirstName: | JOANN | ||||||||
| MiddleName: | |||||||||
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| Credential: | BCBA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | FRYE | ||||||||
| OtherFirstName: | JOANN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6225 SMITH AVE STE 1001A | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212093626 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1210 FOURIER DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537171969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8442631613 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2022 | ||||||||
| LastUpdateDate: | 03/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 516-140 | WI | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.