Provider Demographics
NPI:1487029807
Name:DONALDSON, STEPHANIE (MED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:DONALDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED CCC-SLP
Mailing Address - Street 1:2307 S SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2269
Mailing Address - Country:US
Mailing Address - Phone:505-553-6444
Mailing Address - Fax:
Practice Address - Street 1:2307 S SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2269
Practice Address - Country:US
Practice Address - Phone:505-553-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13728121-4102235Z00000X
GASLP009092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist