Provider Demographics
NPI:1134309917
Name:MCDONALD, EDWARD JAY (MS)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JAY
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 E CURTIS ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2358
Mailing Address - Country:US
Mailing Address - Phone:307-745-4265
Mailing Address - Fax:
Practice Address - Street 1:801 S 24TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4920
Practice Address - Country:US
Practice Address - Phone:307-721-4460
Practice Address - Fax:307-721-4444
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYA-912231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist