Provider Demographics
NPI:1881422400
Name:MACDONALD, JULIANNE (CCC MS SLP)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:CCC MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7305 LA MANGA DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-3041
Mailing Address - Country:US
Mailing Address - Phone:972-489-7421
Mailing Address - Fax:
Practice Address - Street 1:951 S BALLARD AVE
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4175
Practice Address - Country:US
Practice Address - Phone:972-429-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120273235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist