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NPI Code Detail

MEDICARE: DONNA JEAN MOLLER LCPC, MS ED, CSADC

MEDICARE: DONNA JEAN MOLLER LCPC, MS ED, CSADC
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
1101YP2500XProfessional CounselorIL

General Provider Information

NPI Number : 1487758009
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA JEAN MOLLER LCPC, MS ED, CSADC
Provider Business Mailing Address
First Line : 3818 N 24TH ST
Second Line :
City : QUINCY
State : IL
Zip : 62305-8628
Country : US
Telephone Number : 217-223-0413
Fax Number :
Provider Business Practice Location Address
First Line : 4409 MAINE ST
Second Line :
City : QUINCY
State : IL
Zip : 62305-5849
Country : US
Telephone Number : 217-223-0423
Fax Number : 217-223-0461
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2006
Last Update Date : 07/08/2007

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Directions to “ DONNA JEAN MOLLER LCPC, MS ED, CSADC” Practice Location

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