Provider Demographics
NPI:1598002917
Name:BERNS-GOULET, DONNA (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BERNS-GOULET
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 MCKEE ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-1112
Mailing Address - Country:US
Mailing Address - Phone:805-641-0950
Mailing Address - Fax:
Practice Address - Street 1:161 MCKEE ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-1112
Practice Address - Country:US
Practice Address - Phone:805-641-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3156235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist