Provider Demographics
NPI:1285876516
Name:DONOVAN, DEIRDRE HENNIGAN (MA CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:HENNIGAN
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:MS
Other - First Name:DEIRDRE
Other - Middle Name:PATRICIA
Other - Last Name:HENNIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:355 E. 73RD ST.
Mailing Address - Street 2:APT 2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:917-572-5595
Mailing Address - Fax:
Practice Address - Street 1:355 E. 73RD ST.
Practice Address - Street 2:APT 2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:917-572-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014425235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist