Provider Demographics
NPI:1235638362
Name:FABRICIUS, DONNA (SLP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:FABRICIUS
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 1:244 HERRICK BROOK RD
Mailing Address - Street 2:
Mailing Address - City:PAWLET
Mailing Address - State:VT
Mailing Address - Zip Code:05761-6602
Mailing Address - Country:US
Mailing Address - Phone:802-325-2610
Mailing Address - Fax:
Practice Address - Street 1:244 HERRICK BROOK RD
Practice Address - Street 2:
Practice Address - City:PAWLET
Practice Address - State:VT
Practice Address - Zip Code:05761-6602
Practice Address - Country:US
Practice Address - Phone:802-325-2610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT144.0115341235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist