Provider Demographics
NPI:1790960268
Name:MCDONALD, CHEQUITA DELANNA (MS CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:CHEQUITA
Middle Name:DELANNA
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 BLUESTEM
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-8516
Mailing Address - Country:US
Mailing Address - Phone:217-355-1071
Mailing Address - Fax:
Practice Address - Street 1:502 BLUESTEM
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-8516
Practice Address - Country:US
Practice Address - Phone:217-355-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007746235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist