Provider Demographics
NPI:1588107726
Name:MCDONALD, MICHAEL A JR (CCC-SLP, TSSLD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:MCDONALD
Suffix:JR
Gender:M
Credentials:CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12004 144TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1507
Mailing Address - Country:US
Mailing Address - Phone:718-570-3946
Mailing Address - Fax:
Practice Address - Street 1:12004 144TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11436-1507
Practice Address - Country:US
Practice Address - Phone:718-570-3946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-20
Last Update Date:2016-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026224235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist