Provider Demographics
NPI:1801097480
Name:FAWCETT, DONNA B (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:B
Last Name:FAWCETT
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 411
Mailing Address - Street 2:
Mailing Address - City:HAZELTON
Mailing Address - State:ND
Mailing Address - Zip Code:58544-0411
Mailing Address - Country:US
Mailing Address - Phone:701-782-4488
Mailing Address - Fax:
Practice Address - Street 1:20 PALM RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-6308
Practice Address - Country:US
Practice Address - Phone:772-530-7861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 3832235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist