Provider Demographics
NPI:1578619458
Name:PREVETT, DONNA K (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:K
Last Name:PREVETT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
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Mailing Address - Street 1:7661 STATE HIGHWAY 789
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-9483
Mailing Address - Country:US
Mailing Address - Phone:307-349-2968
Mailing Address - Fax:307-332-5604
Practice Address - Street 1:14 GREAT PLAINS ROAD
Practice Address - Street 2:
Practice Address - City:ARAPAHOE
Practice Address - State:WY
Practice Address - Zip Code:82510-0014
Practice Address - Country:US
Practice Address - Phone:307-856-9281
Practice Address - Fax:307-463-4489
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-295235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY122901000Medicaid