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1053795179 NPI number — MELISSA ANNE DONAHUE LCSW

NPI Number: 1053795179
Health Care Provider/Practitioner: MELISSA ANNE DONAHUE LCSW

Information about “1053795179” NPI (MELISSA ANNE DONAHUE LCSW) exists in 1053795179 in HTML format HTML  |  1053795179 in plain Text format TXT  |  1053795179 in PDF (Portable Document Format) PDF  |  1053795179 in an XML format XML  formats.

NPI Number : 1053795179 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053795179",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DONAHUE",
    "FirstName": "MELISSA",
    "MiddleName": "ANNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WILKES",
    "OtherFirstName": "MELISSA",
    "OtherMiddleName": "ANNE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LCSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "15755 56TH AVE N",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PLYMOUTH",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55446-2984",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "901-338-6256",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "865 HARBOR BEND RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MEMPHIS",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "38103-0820",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "901-338-6256",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/18/2015",
    "LastUpdateDate": "02/03/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "34773",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "6064",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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