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General NPI Number Information
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NPI Number | 1265900856
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Entity Type | Individual
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Provider Name | ELIZABETH MCDONALD
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Gender | Female
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 549 NW LAKE WHITNEY PL STE 104
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-1606
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Country | US
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Telephone | 772-301-1207
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Fax | 772-301-1255
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Provider Business Mailing Address
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Address Line | 6312 SW BANKS ST
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City | PALM CITY
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State | FL
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Zip | 34990-5815
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Country | US
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Telephone | 561-508-0384
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA5688
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License Number State | FL
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