Provider Demographics
NPI:1841507852
Name:CHUBB, DONNA RAE (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:RAE
Last Name:CHUBB
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12355 SHELL BEACH TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7099
Mailing Address - Country:US
Mailing Address - Phone:904-228-7568
Mailing Address - Fax:904-220-2593
Practice Address - Street 1:12355 SHELL BEACH TRL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7099
Practice Address - Country:US
Practice Address - Phone:904-228-7568
Practice Address - Fax:904-220-2593
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2451235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist