Healthcare Provider Details

I. General information

NPI: 1194632083
Provider Name (Legal Business Name): JOSEPH DONOHUE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 W CAPITOL DR
MILWAUKEE WI
53216-2040
US

IV. Provider business mailing address

5225 W VLIET ST
MILWAUKEE WI
53208-2698
US

V. Phone/Fax

Practice location:
  • Phone: 414-369-2285
  • Fax:
Mailing address:
  • Phone: 414-475-8393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number856301
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: