Provider Demographics
NPI:1598018830
Name:CITRIN, DONNA WHITE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:WHITE
Last Name:CITRIN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5447 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-4009
Mailing Address - Country:US
Mailing Address - Phone:313-832-1100
Mailing Address - Fax:313-832-3025
Practice Address - Street 1:2075 E WEST MAPLE RD
Practice Address - Street 2:B-204
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-3816
Practice Address - Country:US
Practice Address - Phone:248-926-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00694943235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist