Provider Demographics
NPI:1770726895
Name:MCDONNELL TRAVERS, AMY KATHLEEN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KATHLEEN
Last Name:MCDONNELL TRAVERS
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 1:5150 EL CAMINO REAL
Mailing Address - Street 2:B 16
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1534
Mailing Address - Country:US
Mailing Address - Phone:650-694-4673
Mailing Address - Fax:650-694-6754
Practice Address - Street 1:5150 EL CAMINO REAL
Practice Address - Street 2:B 16
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1534
Practice Address - Country:US
Practice Address - Phone:650-694-4673
Practice Address - Fax:650-694-6754
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP118949235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist