Provider Demographics
NPI:1053689646
Name:FORT-BRENNAN, DONNA ANN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:ANN
Last Name:FORT-BRENNAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1944
Mailing Address - Country:US
Mailing Address - Phone:631-509-5551
Mailing Address - Fax:
Practice Address - Street 1:76 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-1944
Practice Address - Country:US
Practice Address - Phone:631-509-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist