Healthcare Provider Details

I. General information

NPI: 1679809495
Provider Name (Legal Business Name): DONNA GASIOR MS LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E JOLLY RD CEI CMHC CRISIS SERVICES
LANSING MI
48910-6818
US

IV. Provider business mailing address

812 E JOLLY RD CEI CMHC CRISIS SERVICES
LANSING MI
48910-6818
US

V. Phone/Fax

Practice location:
  • Phone: 517-346-8312
  • Fax: 517-346-8446
Mailing address:
  • Phone: 517-346-8312
  • Fax: 517-346-8446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301013468
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: