Basic Information
| Provider Information | |||||||||
| NPI: | 1942646997 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELCHER | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | BC-HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2725 N WESTWOOD BLVD STE 3 | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639012367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736866500 | ||||||||
| FaxNumber: | 5736866503 | ||||||||
| Practice Location | |||||||||
| Address1: | 2725 N WESTWOOD BLVD STE 3 | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639012367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736866500 | ||||||||
| FaxNumber: | 5736866503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2013 | ||||||||
| LastUpdateDate: | 05/17/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 1015 | MO | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 1053468017 | 05 | MO | MEDICAID |