Healthcare Provider Details

I. General information

NPI: 1942147293
Provider Name (Legal Business Name): MARY EILEEN MCDONOUGH AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7317 DARTMOOR AVE
GREENDALE WI
53129-2238
US

IV. Provider business mailing address

7317 DARTMOOR AVE
GREENDALE WI
53129-2238
US

V. Phone/Fax

Practice location:
  • Phone: 262-212-5055
  • Fax:
Mailing address:
  • Phone: 262-212-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAP4538
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number545-156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: