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NPI Code Detail

MEDICARE: TACY DONNELLY

MEDICARE: TACY DONNELLY
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
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1851220578
Entity Type Code : Individual
Provider Name (Legal Business Name) : TACY DONNELLY
Provider Business Mailing Address
First Line : 4570 VICTORIA ST N
Second Line :
City : SHOREVIEW
State : MN
Zip : 55126-5800
Country : US
Telephone Number : 651-621-6130
Fax Number :
Provider Business Practice Location Address
First Line : 4570 VICTORIA ST N
Second Line :
City : SHOREVIEW
State : MN
Zip : 55126-5800
Country : US
Telephone Number : 651-621-6130
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2026
Last Update Date : 05/18/2026

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Directions to “ TACY DONNELLY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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