Healthcare Provider Details

I. General information

NPI: 1629654892
Provider Name (Legal Business Name): HEATHER MCDONALD SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 66TH ST STE D
LUBBOCK TX
79414-4875
US

IV. Provider business mailing address

4601 66TH ST STE D
LUBBOCK TX
79414-4875
US

V. Phone/Fax

Practice location:
  • Phone: 866-832-1708
  • Fax: 888-789-4391
Mailing address:
  • Phone: 866-832-1708
  • Fax: 888-789-4391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18102
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: