Provider Demographics
NPI:1629373956
Name:DONAHOE, MARY GRACE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:GRACE
Last Name:DONAHOE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 WEST END AVE
Mailing Address - Street 2:APT. 6N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:646-262-6292
Mailing Address - Fax:
Practice Address - Street 1:495 W END AVE
Practice Address - Street 2:6N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4351
Practice Address - Country:US
Practice Address - Phone:646-262-6292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0074871235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist