Provider Demographics
NPI:1740409267
Name:COLCORD, DONNA JO (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:JO
Last Name:COLCORD
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:BGSU SPEECH AND HEARING CLINIC
Mailing Address - Street 2:200 HEALTH CENTER BUILDING
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43403-0149
Mailing Address - Country:US
Mailing Address - Phone:419-372-2515
Mailing Address - Fax:419-372-8089
Practice Address - Street 1:BGSU SPEECH AND HEARING CLINIC
Practice Address - Street 2:200 HEALTH CENTER BUILDING
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43403-0149
Practice Address - Country:US
Practice Address - Phone:419-372-2515
Practice Address - Fax:419-372-8089
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP2723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist