Provider Demographics
NPI:1043793409
Name:DEVILLIER, DONNELL LEE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DONNELL
Middle Name:LEE
Last Name:DEVILLIER
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:PO BOX 694
Mailing Address - Street 2:
Mailing Address - City:NOME
Mailing Address - State:TX
Mailing Address - Zip Code:77629-0694
Mailing Address - Country:US
Mailing Address - Phone:409-782-9415
Mailing Address - Fax:
Practice Address - Street 1:705 HIGHWAY 418 W
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-3635
Practice Address - Country:US
Practice Address - Phone:409-782-9415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist