Provider Demographics
NPI:1487661856
Name:KING, DONA DIANE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:DONA
Middle Name:DIANE
Last Name:KING
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-3129
Mailing Address - Country:US
Mailing Address - Phone:217-259-2953
Mailing Address - Fax:
Practice Address - Street 1:440 HIGHWAY 59 LOOP S
Practice Address - Street 2:STE 104
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9096
Practice Address - Country:US
Practice Address - Phone:936-328-8148
Practice Address - Fax:936-327-2491
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146002991235Z00000X
TX107336235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001532016OtherBLUE CROSS BLUE SHIELD