Basic Information
| Provider Information | |||||||||
| NPI: | 1952760951 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONNELLY | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 189 | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805300189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036972583 | ||||||||
| FaxNumber: | 3038339183 | ||||||||
| Practice Location | |||||||||
| Address1: | 5995 IRIS PKWY | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805046412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036972583 | ||||||||
| FaxNumber: | 3038339183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2016 | ||||||||
| LastUpdateDate: | 10/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSYC.00013623 | CO | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.