Provider Demographics
NPI:1003036872
Name:DONATH, JENNIFER ELENA (CCC-A, AUD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELENA
Last Name:DONATH
Suffix:
Gender:F
Credentials:CCC-A, AUD
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ELENA
Other - Last Name:ORR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-A, AUD
Mailing Address - Street 1:107 NEWTOWN RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4180
Mailing Address - Country:US
Mailing Address - Phone:203-830-4700
Mailing Address - Fax:203-730-4165
Practice Address - Street 1:107 NEWTOWN RD STE 2A
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4180
Practice Address - Country:US
Practice Address - Phone:203-830-4700
Practice Address - Fax:203-730-4165
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000365231H00000X
NY002107231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT02889485Medicaid
NYMA002WT151Medicare PIN