Provider Demographics
NPI:1639593221
Name:DONAHUE, STEPHANIE M (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:M
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:M
Other - Last Name:MANSANTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3169 S BOWN WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5400
Mailing Address - Country:US
Mailing Address - Phone:208-433-9152
Mailing Address - Fax:208-344-4752
Practice Address - Street 1:3169 S BOWN WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-5400
Practice Address - Country:US
Practice Address - Phone:208-433-9152
Practice Address - Fax:208-344-4752
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-2333235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist