Healthcare Provider Details

I. General information

NPI: 1396960407
Provider Name (Legal Business Name): BEVERLY MCDONELL SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N BELFIELD AVE
HAVERTOWN PA
19083-4904
US

IV. Provider business mailing address

676 VASSAR RD
STRAFFORD PA
19087-5340
US

V. Phone/Fax

Practice location:
  • Phone: 610-449-1600
  • Fax:
Mailing address:
  • Phone: 610-585-6728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL003745L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: