Provider Demographics
NPI:1730346552
Name:BLACK, DONNA M (SLP)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:BLACK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N OREGON ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-3624
Mailing Address - Country:US
Mailing Address - Phone:406-683-5105
Mailing Address - Fax:406-683-6388
Practice Address - Street 1:200 N OREGON ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3624
Practice Address - Country:US
Practice Address - Phone:406-683-5105
Practice Address - Fax:406-683-6388
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1172235Z00000X
KY263543235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist