MEDICARE: ANDREA MCDONNELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	0749	WV

General Provider Information

NPI Number	:	1447708185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA MCDONNELL

Provider Business Mailing Address
First Line	:	2507 9TH AVE
Second Line	:
City	:	PARKERSBURG
State	:	WV
Zip	:	26101-5855
Country	:	US
Telephone Number	:	304-485-6513
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 58TH ST
Second Line	:
City	:	VIENNA
State	:	WV
Zip	:	26105-2027
Country	:	US
Telephone Number	:	304-485-6513
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2016
Last Update Date	:	09/12/2016

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Directions to “ ANDREA MCDONNELL ” Practice Location

Language	Start Address	Practice Location

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