Provider Demographics
NPI:1528308160
Name:MACDONALD, GINGER ANN (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:ANN
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 OAK KNOLL DR APT 4
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7080
Mailing Address - Country:US
Mailing Address - Phone:608-609-5724
Mailing Address - Fax:
Practice Address - Street 1:3311 OAK KNOLL DR APT 4
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7080
Practice Address - Country:US
Practice Address - Phone:608-609-5724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2304-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist