Provider Demographics
NPI:1912357757
Name:MCDONALD, MELISSA RAE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RAE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 STONE RUN DR
Mailing Address - Street 2:
Mailing Address - City:RISING SUN
Mailing Address - State:MD
Mailing Address - Zip Code:21911-2160
Mailing Address - Country:US
Mailing Address - Phone:610-762-7182
Mailing Address - Fax:
Practice Address - Street 1:103 STONE RUN DR
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-2160
Practice Address - Country:US
Practice Address - Phone:610-762-7182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06752235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist