Provider Demographics
NPI:1942646997
Name:BELCHER, DONNA SUE (BC-HIS)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:SUE
Last Name:BELCHER
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 N WESTWOOD BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2367
Mailing Address - Country:US
Mailing Address - Phone:573-686-6500
Mailing Address - Fax:573-686-6503
Practice Address - Street 1:2725 N WESTWOOD BLVD STE 3
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2367
Practice Address - Country:US
Practice Address - Phone:573-686-6500
Practice Address - Fax:573-686-6503
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1015237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1053468017Medicaid