Provider Demographics
NPI:1043611072
Name:MCDONALD, PATRICE (SLP)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:MCDONALD
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 1:1304 MIDLAND AVE APT C75
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1445
Mailing Address - Country:US
Mailing Address - Phone:917-293-2050
Mailing Address - Fax:
Practice Address - Street 1:1304 MIDLAND AVE APT C75
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1445
Practice Address - Country:US
Practice Address - Phone:917-293-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011529235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist