Provider Demographics
NPI:1154478659
Name:DEVRIES, DONNA (SLP,CCC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:SLP,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 S WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5578
Mailing Address - Country:US
Mailing Address - Phone:417-864-3430
Mailing Address - Fax:417-864-3449
Practice Address - Street 1:215 S BARNES AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2204
Practice Address - Country:US
Practice Address - Phone:417-864-3430
Practice Address - Fax:417-864-3449
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0112235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist