MEDICARE: ELIZABETH I DONNER MS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1922309020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH I DONNER MS

Provider Business Mailing Address
First Line	:	342 ANNETTE CT NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-4801
Country	:	US
Telephone Number	:	503-434-7462
Fax Number	:	503-434-7335

Provider Business Practice Location Address
First Line	:	4422 NE DEVILS LAKE BLVD
Second Line	:	SUITE 2
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-5000
Country	:	US
Telephone Number	:	541-265-4196
Fax Number	:	541-574-6252

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

Provider Enumeration Date	:	11/05/2010
Last Update Date	:	12/02/2016

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