Provider Demographics
NPI:1497025852
Name:DONOHUE, MAUREEN ANNE GLEASON (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANNE GLEASON
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:ANNE
Other - Last Name:GLEASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:2795 PILOT KNOB RD STE 100
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1930
Mailing Address - Country:US
Mailing Address - Phone:651-994-9644
Mailing Address - Fax:
Practice Address - Street 1:2795 PILOT KNOB RD STE 100
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1930
Practice Address - Country:US
Practice Address - Phone:651-994-9644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8725235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist