Provider Demographics
NPI:1811958515
Name:MCDONALD, MARY O'FARRELL (MS AUD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:O'FARRELL
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MS AUD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LYNN
Other - Last Name:O'FARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS AUD
Mailing Address - Street 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:2727 W HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1669
Practice Address - Country:US
Practice Address - Phone:713-442-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50172231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1669350001Medicaid
TX1407825284Medicare UPIN
TX8B7740Medicare ID - Type Unspecified