Provider Demographics
NPI:1962007062
Name:MCDONALD, RYANN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RYANN
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 SE PHARIS RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MO
Mailing Address - Zip Code:64439-8171
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 KOONTZ LN
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-5513
Practice Address - Country:US
Practice Address - Phone:775-883-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist