Healthcare Provider Details

I. General information

NPI: 1164260204
Provider Name (Legal Business Name): ASHLEY DONHAM LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 E MICHIGAN AVE STE 440
KALAMAZOO MI
49007-6400
US

IV. Provider business mailing address

229 E MICHIGAN AVE STE 440
KALAMAZOO MI
49007-6400
US

V. Phone/Fax

Practice location:
  • Phone: 269-254-6613
  • Fax: 269-443-2166
Mailing address:
  • Phone: 269-254-6613
  • Fax: 269-443-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6351004706
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: