MEDICARE: ROBERT DONOHOO MS ED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	166.000849	IL

General Provider Information

NPI Number	:	1447550678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT DONOHOO MS ED

Provider Business Mailing Address
First Line	:	1800 3RD AVE
Second Line	:	SUITE 512
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-8000
Country	:	US
Telephone Number	:	309-786-4491
Fax Number	:	309-786-0205

Provider Business Practice Location Address
First Line	:	1800 3RD AVE
Second Line	:	SUITE 512
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-8000
Country	:	US
Telephone Number	:	309-786-4491
Fax Number	:	309-786-0205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2010
Last Update Date	:	11/28/2011

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