Provider Demographics
NPI:1063765550
Name:SIMMONS, DONNA ELLEN (MS, CCC-SPL)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:ELLEN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MS, CCC-SPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 COUNTY ROAD 4022
Mailing Address - Street 2:
Mailing Address - City:HOLTS SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:65043-1924
Mailing Address - Country:US
Mailing Address - Phone:573-295-4381
Mailing Address - Fax:
Practice Address - Street 1:649 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:SAINT ELIZABETH
Practice Address - State:MO
Practice Address - Zip Code:65075-2440
Practice Address - Country:US
Practice Address - Phone:573-493-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-21
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117825235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist