Active NPI
Stacy-Ann Donovan
- Speech-Language Pathologist
- North Wales, PA
National Provider Identifier
1497319370
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLO13761
- Practice address
- 104 Clayton CT
North Wales, PA 19454-1827 - Phone
- (484) 808-7428
- NPI assigned
- Apr 26, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLO13761 | PA | Primary |
Addresses
Primary practice location
104 Clayton CT
North Wales, PA 19454-1827
Mailing address
104 Clayton CT
North Wales, PA 19454-1827
Phone (484) 808-7428
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLO13761 | PA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728864000000",
"number": "1497319370",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 CLAYTON CT",
"city": "NORTH WALES",
"state": "PA",
"postal_code": "194541827",
"telephone_number": "484-808-7428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 CLAYTON CT",
"city": "NORTH WALES",
"state": "PA",
"postal_code": "194541827",
"telephone_number": "484-808-7428"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONOVAN",
"first_name": "STACY-ANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-04-26",
"last_updated": "2024-10-14",
"certification_date": "2024-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": "PA",
"license": "SLO13761",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Wales, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.