Individual
DONNA POLELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
4202 E FOWLER AVE, PCD1017, TAMPA, FL 33620-6750
(813) 974-9844
(813) 974-0822
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA10941
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004428700
—
FL
01
—
S00QC
BLUE CROSS BLUE SHIELD
FL
Enumeration date
08/24/2009
Last updated
07/19/2012
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