Provider Demographics
NPI:1336845221
Name:MCDONALD, JULIE KATHLEEN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:KATHLEEN
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 1:121 CLARA AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4012
Mailing Address - Country:US
Mailing Address - Phone:314-605-6370
Mailing Address - Fax:
Practice Address - Street 1:17050 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63011-1794
Practice Address - Country:US
Practice Address - Phone:636-733-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist