Provider Demographics
NPI:1205170750
Name:BOHDAL, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BOHDAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GREENWAY PLANTATION
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-5024
Mailing Address - Country:US
Mailing Address - Phone:321-368-2600
Mailing Address - Fax:
Practice Address - Street 1:16 GREENWAY PLANTATION
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-5024
Practice Address - Country:US
Practice Address - Phone:321-369-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-23
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2161235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist