Healthcare Provider Details

I. General information

NPI: 1932876497
Provider Name (Legal Business Name): DONNA KAY EADS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONNA KAY BARTEL

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E SAINT JOSEPH ST
GREEN BAY WI
54301-2241
US

IV. Provider business mailing address

744 S WEBSTER AVE MEDICAL STAFF SERVICES
GREEN BAY WI
54301
US

V. Phone/Fax

Practice location:
  • Phone: 920-433-6073
  • Fax: 920-431-0333
Mailing address:
  • Phone:
  • Fax: 920-433-6090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11582-123
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: