Provider Demographics
NPI:1144629403
Name:KULAKOWSKI, DONNA (PHD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:KULAKOWSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 HENNEPIN AVE # 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2619
Mailing Address - Country:US
Mailing Address - Phone:612-226-2570
Mailing Address - Fax:
Practice Address - Street 1:3108 HENNEPIN AVE # 1
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2619
Practice Address - Country:US
Practice Address - Phone:612-226-2570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 2372103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling