Provider Demographics
NPI:1760617179
Name:BRODEN, DONNA WILKINSON (SLP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:WILKINSON
Last Name:BRODEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 ROWAN AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75223-3033
Mailing Address - Country:US
Mailing Address - Phone:214-392-5776
Mailing Address - Fax:214-821-3160
Practice Address - Street 1:1321 ROWAN AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75223-3033
Practice Address - Country:US
Practice Address - Phone:214-392-5776
Practice Address - Fax:214-821-6130
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1842235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist