Provider Demographics
NPI:1700083896
Name:VANDONSEL, MARY N (MSR,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:N
Last Name:VANDONSEL
Suffix:
Gender:F
Credentials:MSR,CCC-SLP
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:N
Other - Last Name:SWOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSR, CCC-SLP
Mailing Address - Street 1:454 BARTNICK RD
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:NY
Mailing Address - Zip Code:13071-9762
Mailing Address - Country:US
Mailing Address - Phone:315-364-8248
Mailing Address - Fax:315-364-8016
Practice Address - Street 1:8842 ROUTE 90
Practice Address - Street 2:MANDEL THERAPY GROUP
Practice Address - City:KING FERRY
Practice Address - State:NY
Practice Address - Zip Code:13081
Practice Address - Country:US
Practice Address - Phone:315-364-7570
Practice Address - Fax:315-364-8016
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014904-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist