Provider Demographics
NPI:1730890997
Name:REYNOLDS, DONNA ELIZABETH (MA)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:ELIZABETH
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:CHRISTOVAL
Mailing Address - State:TX
Mailing Address - Zip Code:76935-0153
Mailing Address - Country:US
Mailing Address - Phone:325-650-2991
Mailing Address - Fax:
Practice Address - Street 1:4637 MOORE RD.
Practice Address - Street 2:
Practice Address - City:CHRISTOVAL
Practice Address - State:TX
Practice Address - Zip Code:76935-7693
Practice Address - Country:US
Practice Address - Phone:325-650-2991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100637235Z00000X
01002842235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01002842OtherAMERICAN SPEECH AND HEARING ASSOCIATION