MEDICARE: SARAH MCDONNELL LLC

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	261QR0400X	Rehabilitation Clinic/Center	015665	OR

General Provider Information

NPI Number	:	1598130965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARAH MCDONNELL LLC

Provider Business Mailing Address
First Line	:	512 CASCADE AVE
Second Line	:	SUITE 100
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-2126
Country	:	US
Telephone Number	:	541-716-1316
Fax Number	:

Provider Business Practice Location Address
First Line	:	512 CASCADE AVE
Second Line	:	SUITE 100
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-2126
Country	:	US
Telephone Number	:	541-716-1316
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	SARAH JANE MCDONNELL
Credential	:	MA CCC-SLP
Telephone Number	:	716-866-0756

Provider Enumeration Date	:	12/10/2015
Last Update Date	:	03/18/2016

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