Provider Demographics
NPI:1063779445
Name:MCDONALD, DAWN DAGANHARDT (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:DAGANHARDT
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 W TARGA CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3668
Mailing Address - Country:US
Mailing Address - Phone:813-505-3882
Mailing Address - Fax:
Practice Address - Street 1:114 W TARGA CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3668
Practice Address - Country:US
Practice Address - Phone:813-505-3882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1022235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA1022OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH