Provider Demographics
NPI:1851029367
Name:BRONNER, DONNA LAJUNE (MHS, CCC, IDFPR)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LAJUNE
Last Name:BRONNER
Suffix:
Gender:F
Credentials:MHS, CCC, IDFPR
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:BRONNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHS, CCC
Mailing Address - Street 1:7600 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-2273
Mailing Address - Country:US
Mailing Address - Phone:630-886-1742
Mailing Address - Fax:
Practice Address - Street 1:1838 S 9TH AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3242
Practice Address - Country:US
Practice Address - Phone:708-299-2075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01137684235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist