MEDICARE: LAUREN DONOVAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1376914457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN DONOVAN

Provider Business Mailing Address
First Line	:	8400 NORTHPORT DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-3202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8400 NORTHPORT DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-3202
Country	:	US
Telephone Number	:	513-474-2270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2015
Last Update Date	:	10/14/2015

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Directions to “ LAUREN DONOVAN ” Practice Location

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