Provider Demographics
NPI:1730394784
Name:MCDONALD, SUSAN Q (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:Q
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BROADALBIN
Mailing Address - State:NY
Mailing Address - Zip Code:12025-2252
Mailing Address - Country:US
Mailing Address - Phone:518-261-1656
Mailing Address - Fax:
Practice Address - Street 1:134 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:BROADALBIN
Practice Address - State:NY
Practice Address - Zip Code:12025-2252
Practice Address - Country:US
Practice Address - Phone:518-261-1656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0036071235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist