Provider Demographics
NPI:1477709137
Name:BANKSON, DONNA ELAINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:ELAINE
Last Name:BANKSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4677 VALLEY EAST BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4630
Mailing Address - Country:US
Mailing Address - Phone:707-822-9122
Mailing Address - Fax:707-822-1969
Practice Address - Street 1:4677 VALLEY EAST BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4630
Practice Address - Country:US
Practice Address - Phone:707-822-9122
Practice Address - Fax:707-822-1969
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11880235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist