Provider Demographics
NPI:1144792623
Name:JONES, DONNA VIDA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:VIDA
Last Name:JONES
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 1:26072 LAKE TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-9691
Mailing Address - Country:US
Mailing Address - Phone:541-913-0924
Mailing Address - Fax:
Practice Address - Street 1:65 W 30TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3485
Practice Address - Country:US
Practice Address - Phone:541-342-5901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16144235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist