Provider Demographics
NPI:1962546556
Name:DONOFRIO, LINDA IRENE (MS SPEECH LANGUAGE P)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:IRENE
Last Name:DONOFRIO
Suffix:
Gender:F
Credentials:MS SPEECH LANGUAGE P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 NE 44TH AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213
Mailing Address - Country:US
Mailing Address - Phone:503-808-9919
Mailing Address - Fax:503-459-4986
Practice Address - Street 1:1827 NE 44TH AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213
Practice Address - Country:US
Practice Address - Phone:503-808-9919
Practice Address - Fax:503-459-4986
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213514Medicaid