Provider Demographics
NPI:1477736023
Name:DONOGHUE, ANN C (MS)
Entity Type:Individual
Prefix:MISS
First Name:ANN
Middle Name:C
Last Name:DONOGHUE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1653
Mailing Address - Country:US
Mailing Address - Phone:201-854-1800
Mailing Address - Fax:201-861-0269
Practice Address - Street 1:6038 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1421
Practice Address - Country:US
Practice Address - Phone:201-854-1800
Practice Address - Fax:201-861-0269
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00064500231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist