Provider Demographics
NPI:1366648990
Name:WIRZBURGER, DONNA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:WIRZBURGER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 WESTGATE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-4120
Mailing Address - Country:US
Mailing Address - Phone:508-995-1769
Mailing Address - Fax:
Practice Address - Street 1:1069 WESTGATE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-4120
Practice Address - Country:US
Practice Address - Phone:508-995-1769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist