Provider Demographics
NPI:1235459348
Name:DONOHUE, SALLY JO (CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:JO
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:JO
Other - Last Name:LONG (MAIDEN)
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1818 SO UNION AVE
Mailing Address - Street 2:#2-C
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1953
Mailing Address - Country:US
Mailing Address - Phone:253-627-7567
Mailing Address - Fax:253-627-4778
Practice Address - Street 1:1818 SO UNION AVE
Practice Address - Street 2:#2-C
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1953
Practice Address - Country:US
Practice Address - Phone:253-627-7567
Practice Address - Fax:253-627-4778
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001723237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter