Provider Demographics
NPI:1710254545
Name:MCDERMOTT, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 N LOOP 1604 W
Mailing Address - Street 2:15208
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4677
Mailing Address - Country:US
Mailing Address - Phone:310-467-7784
Mailing Address - Fax:
Practice Address - Street 1:1703 N LOOP 1604 W
Practice Address - Street 2:15208
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4677
Practice Address - Country:US
Practice Address - Phone:310-467-7784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105674235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist