Provider Demographics
NPI:1407227374
Name:MOORE, DONNA (AUD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:GRITTANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:618 E STAR CT
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-6700
Mailing Address - Country:US
Mailing Address - Phone:970-249-3971
Mailing Address - Fax:970-249-0219
Practice Address - Street 1:618 E STAR CT
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-6700
Practice Address - Country:US
Practice Address - Phone:970-249-3971
Practice Address - Fax:970-249-0219
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD.0000782231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist