MEDICARE: KACIE MCDONOUGH

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

General Provider Information

NPI Number	:	1689343188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KACIE MCDONOUGH

Provider Business Mailing Address
First Line	:	28 TAMARACK RD
Second Line	:
City	:	MAHOPAC
State	:	NY
Zip	:	10541-1425
Country	:	US
Telephone Number	:	845-531-9438
Fax Number	:

Provider Business Practice Location Address
First Line	:	192 E 151ST ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-5292
Country	:	US
Telephone Number	:	845-531-9438
Fax Number	:

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

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	09/08/2021

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Directions to “ KACIE MCDONOUGH ” Practice Location

Language	Start Address	Practice Location

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