Provider Demographics
NPI:1609174606
Name:SPIKES, DONNA RENEE (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:DONNA
Middle Name:RENEE
Last Name:SPIKES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 STONE MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-5944
Mailing Address - Country:US
Mailing Address - Phone:706-955-7607
Mailing Address - Fax:
Practice Address - Street 1:4405 EVANS TO LOCKS RD
Practice Address - Street 2:SUITE C
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3603
Practice Address - Country:US
Practice Address - Phone:706-854-1598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007481235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA235Z00000XMedicaid