Basic Information
| Provider Information | |||||||||
| NPI: | 1730346552 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLACK | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 N OREGON ST | ||||||||
| Address2: | |||||||||
| City: | DILLON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597253624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066835105 | ||||||||
| FaxNumber: | 4066836388 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 N OREGON ST | ||||||||
| Address2: | |||||||||
| City: | DILLON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597253624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066835105 | ||||||||
| FaxNumber: | 4066836388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2008 | ||||||||
| LastUpdateDate: | 04/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 1172 | MT | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 263543 | KY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.