Healthcare Provider Details

I. General information

NPI: 1871757633
Provider Name (Legal Business Name): AMY MCDONOUGH AUD, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

783 N DENTON TAP RD STE 200
COPPELL TX
75019-2171
US

IV. Provider business mailing address

783 N DENTON TAP RD STE 200
COPPELL TX
75019-2171
US

V. Phone/Fax

Practice location:
  • Phone: 972-745-8400
  • Fax: 972-315-9053
Mailing address:
  • Phone: 972-745-8400
  • Fax: 972-315-9053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number51512
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: