Provider Demographics
NPI:1699918748
Name:FITZGERALD-DEJEAN, DONNA M (PHD, CCC/SLP)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:FITZGERALD-DEJEAN
Suffix:
Gender:F
Credentials:PHD, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8617 SCARLETT DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8527
Mailing Address - Country:US
Mailing Address - Phone:225-925-1681
Mailing Address - Fax:
Practice Address - Street 1:8617 SCARLETT DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8527
Practice Address - Country:US
Practice Address - Phone:225-925-1681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-18
Last Update Date:2009-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA597235Z00000X
FLSA 2171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist