MEDICARE: DARCY MCCONNELL M.A., CCC-SLP

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	24934	TX

General Provider Information

NPI Number	:	1427312115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARCY MCCONNELL M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	1118 W MISTLETOE AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-5653
Country	:	US
Telephone Number	:	210-260-9453
Fax Number	:

Provider Business Practice Location Address
First Line	:	1118 W MISTLETOE AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-5653
Country	:	US
Telephone Number	:	210-260-9453
Fax Number	:

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

Provider Enumeration Date	:	06/27/2012
Last Update Date	:	06/27/2012

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