Individual
JEAN E DONNELLY-HICKS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MA CCC SLP
Contact information
Practice address
3915 GOLDEN VALLEY ROAD, COURAGE CENTER, GOLDEN VALLEY, MN 55422-4298
(763) 520-0367
(763) 520-0355
Mailing address
3915 GOLDEN VALLEY ROAD, COURAGE CENTER, GOLDEN VALLEY, MN 55422-4298
(763) 520-0367
(763) 520-0355
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5666
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04T48DO
BCBS
MN
01
—
4600065
MEDICA
—
01
—
HP42475
HEALTHPARTNERS
—
Enumeration date
05/03/2006
Last updated
07/08/2007
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