Provider Demographics
NPI:1780793620
Name:MCDONALD, REBECCA WILLEY (AUD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:WILLEY
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W RANDOL MILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-5810
Mailing Address - Country:US
Mailing Address - Phone:817-277-7039
Mailing Address - Fax:817-801-3231
Practice Address - Street 1:101 W RANDOL MILL RD STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5810
Practice Address - Country:US
Practice Address - Phone:817-277-7039
Practice Address - Fax:817-801-3231
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51684231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80447AOtherBCBS PROVIDER NUMBER
TX8D9804Medicare ID - Type Unspecified