MEDICARE: KAITLYN MCDONALD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	5592	TN

General Provider Information

NPI Number	:	1275986754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN MCDONALD

Provider Business Mailing Address
First Line	:	1303 FENNER CT
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-8538
Country	:	US
Telephone Number	:	615-972-7839
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 FENNER CT
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-8538
Country	:	US
Telephone Number	:	615-972-7839
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2016
Last Update Date	:	07/19/2016

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Directions to “ KAITLYN MCDONALD ” Practice Location

Language	Start Address	Practice Location

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