Provider Demographics
NPI:1609171750
Name:MCDADE, JERILYN (MA-CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:JERILYN
Middle Name:
Last Name:MCDADE
Suffix:
Gender:F
Credentials:MA-CCC/SLP
Other - Prefix:MS
Other - First Name:JERILYN
Other - Middle Name:ANN
Other - Last Name:DALIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA-CCC/SLP
Mailing Address - Street 1:118 E COLD HOLLOW FARMS DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6725
Mailing Address - Country:US
Mailing Address - Phone:917-647-9558
Mailing Address - Fax:
Practice Address - Street 1:118 E COLD HOLLOW FARMS DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6725
Practice Address - Country:US
Practice Address - Phone:917-647-9558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist