Provider Demographics
NPI:1699389023
Name:JOHNSON, DONNA FAYE
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:FAYE
Last Name:JOHNSON
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 1:202 LEE ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-3306
Mailing Address - Country:US
Mailing Address - Phone:304-952-0265
Mailing Address - Fax:
Practice Address - Street 1:508 NEW HOPE RD STE 19
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2272
Practice Address - Country:US
Practice Address - Phone:304-487-2487
Practice Address - Fax:304-431-3367
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1020237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist