Provider Demographics
NPI:1568014744
Name:MACDONALD, MARY (SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 MONROE ST APT 17
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6694
Mailing Address - Country:US
Mailing Address - Phone:908-380-4808
Mailing Address - Fax:
Practice Address - Street 1:171 MADISON AVE FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5123
Practice Address - Country:US
Practice Address - Phone:212-400-0383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist