Provider Demographics
NPI:1649763251
Name:DONOFRIO, COREEN ROSE
Entity Type:Individual
Prefix:
First Name:COREEN
Middle Name:ROSE
Last Name:DONOFRIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 SANCTUARY ST
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-0692
Mailing Address - Country:US
Mailing Address - Phone:630-802-6117
Mailing Address - Fax:
Practice Address - Street 1:2580 SANCTUARY ST
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-0692
Practice Address - Country:US
Practice Address - Phone:630-802-6117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.005097235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist