Provider Demographics
NPI:1811016082
Name:MAZUR, DONNA J (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:J
Last Name:MAZUR
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 1:240 KEOKUK ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2727
Mailing Address - Country:US
Mailing Address - Phone:707-762-2269
Mailing Address - Fax:707-762-2269
Practice Address - Street 1:240 KEOKUK ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2727
Practice Address - Country:US
Practice Address - Phone:707-762-2269
Practice Address - Fax:707-762-2269
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP13115235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist