Basic Information
| Provider Information | |||||||||
| NPI: | 1720299159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELENKIWICH | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 BERGSLIEN ST | ||||||||
| Address2: | |||||||||
| City: | BALDWIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540022600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156841111 | ||||||||
| FaxNumber: | 7156841524 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 BERGSLIEN ST | ||||||||
| Address2: | |||||||||
| City: | BALDWIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540022600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156841111 | ||||||||
| FaxNumber: | 7156841119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2007 | ||||||||
| LastUpdateDate: | 03/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 3890-125 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.