Provider Demographics
NPI:1356658751
Name:DONAHUE, ELIZABETH (MA, CFY-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:MA, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2846 BRANDT DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8805
Mailing Address - Country:US
Mailing Address - Phone:701-232-2340
Mailing Address - Fax:701-232-2330
Practice Address - Street 1:2846 BRANDT DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8805
Practice Address - Country:US
Practice Address - Phone:701-232-2340
Practice Address - Fax:701-232-2330
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1138235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1138OtherNORTH DAKOTA LICENSE