Provider Demographics
NPI:1417206061
Name:WALDEN, DONNA HUTTON (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:HUTTON
Last Name:WALDEN
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-4841
Mailing Address - Country:US
Mailing Address - Phone:901-268-9231
Mailing Address - Fax:
Practice Address - Street 1:2507 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-4841
Practice Address - Country:US
Practice Address - Phone:901-268-9231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist