Provider Demographics
NPI:1609151935
Name:CREEGAN, DONNA (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:CREEGAN
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4324 RIDGE RD
Mailing Address - Street 2:PO 47
Mailing Address - City:ELBA
Mailing Address - State:NY
Mailing Address - Zip Code:14058-9763
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4324 RIDGE RD
Practice Address - Street 2:PO 47
Practice Address - City:ELBA
Practice Address - State:NY
Practice Address - Zip Code:14058-9763
Practice Address - Country:US
Practice Address - Phone:585-734-7416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005038-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist