MEDICARE: MS. DONNA A. WAKELEY MS CCC SLP LIC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	005294-1	NY

General Provider Information

NPI Number	:	1144549023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONNA A. WAKELEY MS CCC SLP LIC.

Provider Business Mailing Address
First Line	:	319 SUFFOLK ST # 56
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14215-3327
Country	:	US
Telephone Number	:	716-816-4330
Fax Number	:	716-838-7530

Provider Business Practice Location Address
First Line	:	319 SUFFOLK ST # 56
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14215-3327
Country	:	US
Telephone Number	:	716-816-4330
Fax Number	:	716-838-7530

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2010
Last Update Date	:	05/18/2010

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