=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780445999
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATE MCDONOUGH MS, CCC-SLP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2024
-----------------------------------------------------
Last Update Date | 01/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 BRADLEY ST APT 2
-----------------------------------------------------
City | BRANFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06405-3536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-282-1462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 BRADLEY ST APT 2
-----------------------------------------------------
City | BRANFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06405-3536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-282-1462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KATE MCDONOUGH
-----------------------------------------------------
Credential | MS, CCC-SLP
-----------------------------------------------------
Telephone | 914-282-1462
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------