Provider Demographics
NPI:1487999546
Name:VANACKEREN, DONNA K
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:K
Last Name:VANACKEREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-3323
Mailing Address - Country:US
Mailing Address - Phone:360-379-4366
Mailing Address - Fax:360-379-4548
Practice Address - Street 1:3939 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-3323
Practice Address - Country:US
Practice Address - Phone:360-379-4366
Practice Address - Fax:360-379-4548
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 00003552235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist