Provider Demographics
NPI:1043594112
Name:DONOHUE, KERRY A (MA, CCC-SLP BILING)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:A
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:MA, CCC-SLP BILING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 GREELEY AVE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2633
Mailing Address - Country:US
Mailing Address - Phone:631-589-5643
Mailing Address - Fax:
Practice Address - Street 1:66 GREELEY AVE
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2633
Practice Address - Country:US
Practice Address - Phone:631-589-5643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009242235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist