MEDICARE: NOE 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	22005948A	IN

General Provider Information

NPI Number	:	1346068517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOE MCDONALD

Provider Business Mailing Address
First Line	:	4320 SWANSON DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46228-2824
Country	:	US
Telephone Number	:	773-450-0787
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 E 16TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-5101
Country	:	US
Telephone Number	:	317-226-4288
Fax Number	:

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

Provider Enumeration Date	:	09/27/2024
Last Update Date	:	09/27/2024

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Directions to “ NOE MCDONALD ” Practice Location

Language	Start Address	Practice Location

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