Provider Demographics
NPI:1780653592
Name:GOTTARDI, DONNA LEE (MSCCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LEE
Last Name:GOTTARDI
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:714 BROUGHAM RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-0306
Mailing Address - Country:US
Mailing Address - Phone:910-488-6844
Mailing Address - Fax:910-488-6844
Practice Address - Street 1:2817 REILLY RD
Practice Address - Street 2:WOMACK ARMY MEDICAL CENTER
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7324
Practice Address - Country:US
Practice Address - Phone:910-907-7332
Practice Address - Fax:910-907-8485
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC153OtherLICENSE NUMBER