Provider Demographics
NPI:1134340458
Name:MCDONALD, GUADALUPE BERNICE (MS, SLP)
Entity type:Individual
Prefix:MS
First Name:GUADALUPE
Middle Name:BERNICE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:MRS
Other - First Name:GUADALUPE
Other - Middle Name:BERNICE
Other - Last Name:BATLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2424 W. HIBBS RD.
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:IN
Mailing Address - Zip Code:47952
Mailing Address - Country:US
Mailing Address - Phone:812-230-1406
Mailing Address - Fax:
Practice Address - Street 1:2424 W. HIBBS RD.
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:IN
Practice Address - Zip Code:47952
Practice Address - Country:US
Practice Address - Phone:812-230-1406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46001583A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist