Provider Demographics
NPI:1043400070
Name:REICHARD, DONNA FARLER (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:FARLER
Last Name:REICHARD
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 FOREST HILLS RD W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3412
Mailing Address - Country:US
Mailing Address - Phone:252-243-7400
Mailing Address - Fax:
Practice Address - Street 1:1811 FOREST HILLS RD W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3412
Practice Address - Country:US
Practice Address - Phone:252-243-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3040235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3040OtherNC BOARD OF EXAMINERS FOR
NC720777YMedicaid
NC0777YOtherBCBS
01083363OtherASHA
NC3040OtherNC BOARD OF EXAMINERS FOR