Basic Information
| Provider Information | |||||||||
| NPI: | 1932295870 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONALDSON | ||||||||
| FirstName: | GILLIAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | SPEECH/LANG PATH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16836 FOUR SEASONS DR | ||||||||
| Address2: | |||||||||
| City: | DUMFRIES | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220253616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036806516 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224015719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403733223 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2202000592 | VA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 036802 | 01 | VA | SENTARA | OTHER | 192571 | 01 | VA | ANTHEM HEALTHKEEP PLUS | OTHER | 245465 | 01 | VA | MDIPA | OTHER | 4978145 | 05 | VA | MEDICAID |