Provider Demographics
NPI:1609155035
Name:MCDONALD, JANIS IRENE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JANIS
Middle Name:IRENE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MA CCC-SLP
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Mailing Address - Street 1:12110 ROCKAWAY BLVD
Mailing Address - Street 2:MS226
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2427
Mailing Address - Country:US
Mailing Address - Phone:718-843-2260
Mailing Address - Fax:
Practice Address - Street 1:12110 ROCKAWAY BLVD
Practice Address - Street 2:MS226
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2427
Practice Address - Country:US
Practice Address - Phone:718-843-2260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2016-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLSA5945235Z00000X, 222Q00000X
NY0254321235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist