Provider Demographics
NPI:1891946455
Name:DONNAWAY, JESSICA ELLEN (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ELLEN
Last Name:DONNAWAY
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:DONNAWAY
Other - Last Name:TILLERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5206
Mailing Address - Country:US
Mailing Address - Phone:970-247-5411
Mailing Address - Fax:
Practice Address - Street 1:201 E 12TH ST
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5206
Practice Address - Country:US
Practice Address - Phone:970-247-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM330291235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM73126837Medicaid