Provider Demographics
NPI:1194229286
Name:LOCKHART, DONNA WARD
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:WARD
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 BOOTH BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614-7049
Mailing Address - Country:US
Mailing Address - Phone:276-935-4551
Mailing Address - Fax:
Practice Address - Street 1:1176 BOOTH BRANCH RD
Practice Address - Street 2:
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614-7049
Practice Address - Country:US
Practice Address - Phone:276-935-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2203000289235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2203000289OtherBOARD OF AUDIOLOGY AND SPEECH-LANGUAGE PATHOLOGY