Healthcare Provider Details

I. General information

NPI: 1134050115
Provider Name (Legal Business Name): DONVILLE A JAMES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DONNY J.

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N GREENLEAF ST STE B
GURNEE IL
60031-3326
US

IV. Provider business mailing address

775 WALNUT ST APT 1W
WAUKEGAN IL
60085-2843
US

V. Phone/Fax

Practice location:
  • Phone: 847-390-2271
  • Fax:
Mailing address:
  • Phone: 847-609-5242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB899564
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: