Provider Demographics
NPI:1134377898
Name:DONESKI-NICOL, JANIS (MS, CCC-SLP, ATP)
Entity type:Individual
Prefix:MS
First Name:JANIS
Middle Name:
Last Name:DONESKI-NICOL
Suffix:
Gender:F
Credentials:MS, CCC-SLP, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 S DYLAN ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-9137
Mailing Address - Country:US
Mailing Address - Phone:928-773-8467
Mailing Address - Fax:928-523-4953
Practice Address - Street 1:3545 S DYLAN ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-9137
Practice Address - Country:US
Practice Address - Phone:928-773-8467
Practice Address - Fax:928-523-4953
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1854235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ742181Medicaid