Provider Demographics
NPI:1811616832
Name:MCDONALD, LISA MARY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARY
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2008 VISTA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-9147
Mailing Address - Country:US
Mailing Address - Phone:830-459-5588
Mailing Address - Fax:830-257-2201
Practice Address - Street 1:2002 SINGING WIND DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3741
Practice Address - Country:US
Practice Address - Phone:830-257-2208
Practice Address - Fax:830-257-2201
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist