Provider Demographics
NPI:1487859120
Name:MCDONALD, ANN E (SLP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:GREEN CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63545-1005
Mailing Address - Country:US
Mailing Address - Phone:660-874-4128
Mailing Address - Fax:660-874-4515
Practice Address - Street 1:373 S MARKET ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MO
Practice Address - Zip Code:63556-1182
Practice Address - Country:US
Practice Address - Phone:660-265-4414
Practice Address - Fax:660-265-4315
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002018383251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)