Provider Demographics
NPI:1013252808
Name:MCDONALD, BRENDA MICHELE' (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MICHELE'
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 NASSAU DR APT 403
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-3754
Mailing Address - Country:US
Mailing Address - Phone:361-463-6357
Mailing Address - Fax:
Practice Address - Street 1:71 NASSAU DR APT 403
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-3754
Practice Address - Country:US
Practice Address - Phone:361-463-6357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17840235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist