Provider Demographics
NPI:1649959842
Name:DONNAN, SIDNEY LIN (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:LIN
Last Name:DONNAN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 FRANK ST
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:IL
Mailing Address - Zip Code:62670-4556
Mailing Address - Country:US
Mailing Address - Phone:217-371-7549
Mailing Address - Fax:
Practice Address - Street 1:58 FRANK ST
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:IL
Practice Address - Zip Code:62670-4556
Practice Address - Country:US
Practice Address - Phone:217-371-7549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146016845235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist