Provider Demographics
NPI:1386912251
Name:DONLON, JENNIFER P (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:DONLON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 PRECINCT LINE RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3132
Mailing Address - Country:US
Mailing Address - Phone:817-282-7250
Mailing Address - Fax:817-282-7251
Practice Address - Street 1:1809 PRECINCT LINE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3132
Practice Address - Country:US
Practice Address - Phone:817-282-7250
Practice Address - Fax:817-282-7251
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18969235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX18969OtherSTATE LICENSE