Basic Information
| Provider Information | |||||||||
| NPI: | 1821237439 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONELL | ||||||||
| FirstName: | LYDIA | ||||||||
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| Credential: | BCBA, SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 BURLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | GREER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644309259 | ||||||||
| FaxNumber: | 8039054431 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 BURLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | GREER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296503904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644309259 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2009 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 235Z00000X | 4614 | SC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.