Provider Demographics
NPI:1629401229
Name:MCDONALD, SARA NICOLE (BA SLP-A)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:NICOLE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:BA SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 ELY ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-1340
Mailing Address - Country:US
Mailing Address - Phone:573-717-1115
Mailing Address - Fax:573-340-1408
Practice Address - Street 1:1600 ELY ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-1340
Practice Address - Country:US
Practice Address - Phone:573-717-1115
Practice Address - Fax:573-340-1408
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220381472355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant