Provider Demographics
NPI:1851664668
Name:HEALEY, DONNA K (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:K
Last Name:HEALEY
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 1:5B FOXFIRE LN
Mailing Address - Street 2:
Mailing Address - City:GLENMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12077-2978
Mailing Address - Country:US
Mailing Address - Phone:518-221-5310
Mailing Address - Fax:
Practice Address - Street 1:475 WATERVLIET SHAKER RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-4622
Practice Address - Country:US
Practice Address - Phone:518-221-5310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017486-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist