Provider Demographics
NPI:1396824611
Name:DONNA M EDGMON SPEECH PATHOLOGY
Entity Type:Organization
Organization Name:DONNA M EDGMON SPEECH PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MANSUETO
Authorized Official - Last Name:EDGMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-751-5504
Mailing Address - Street 1:2700 AMERICAN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-6937
Mailing Address - Country:US
Mailing Address - Phone:479-751-5504
Mailing Address - Fax:479-751-6446
Practice Address - Street 1:2700 AMERICAN ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-6937
Practice Address - Country:US
Practice Address - Phone:479-751-5504
Practice Address - Fax:479-751-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C075OtherBL;UE CROSS CLINIC #