MEDICARE: DONNA GORJON

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	07066

General Provider Information

NPI Number	:	1447819446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA GORJON

Provider Business Mailing Address
First Line	:	3901 DENFELD AVE
Second Line	:
City	:	KENSINGTON
State	:	MD
Zip	:	20895-1510
Country	:	US
Telephone Number	:	240-740-0920
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 DENFELD AVE
Second Line	:
City	:	KENSINGTON
State	:	MD
Zip	:	20895-1510
Country	:	US
Telephone Number	:	240-740-0920
Fax Number	:

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

Provider Enumeration Date	:	06/12/2019
Last Update Date	:	06/13/2019

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Directions to “ DONNA GORJON ” Practice Location

Language	Start Address	Practice Location

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