Provider Demographics
NPI:1396223293
Name:MCDONALD, AVIE GAIL SOCORRO DELA CERNA (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:AVIE GAIL SOCORRO
Middle Name:DELA CERNA
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 W CRAPE RD
Mailing Address - Street 2:GUADALUPE
Mailing Address - City:QUEEN CREEK
Mailing Address - State:CEBU CITY
Mailing Address - Zip Code:85140
Mailing Address - Country:PH
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1560 W CRAPE RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85140-7818
Practice Address - Country:US
Practice Address - Phone:480-438-9341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5279340235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist