Provider Demographics
NPI:1366401531
Name:DONALDSON, DONNA JEAN (AUD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:JEAN
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:JEAN
Other - Last Name:DONALDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD,
Mailing Address - Street 1:77 WEST FOREST AVE,
Mailing Address - Street 2:SUITE 212
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001
Mailing Address - Country:US
Mailing Address - Phone:928-773-2218
Mailing Address - Fax:928-773-2287
Practice Address - Street 1:77 W FOREST AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1479
Practice Address - Country:US
Practice Address - Phone:928-773-2218
Practice Address - Fax:928-773-2287
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA5862237600000X
MO200200998231H00000X
IA00457231H00000X
IA00757237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO338310303Medicaid
MO338310303Medicaid