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NPI Code Detail

MEDICARE: JENNIFER MCDONOUGH

MEDICARE:   JENNIFER  MCDONOUGH
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
1235Z00000XSpeech-Language PathologistSP10414OH

General Provider Information

NPI Number : 1659794550
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MCDONOUGH
Provider Business Mailing Address
First Line : 98 WASHINGTON BLVD
Second Line : APT 4
City : YOUNGSTOWN
State : OH
Zip : 44512-6348
Country : US
Telephone Number : 330-397-5243
Fax Number :
Provider Business Practice Location Address
First Line : 38720 SALTWELL RD
Second Line :
City : LISBON
State : OH
Zip : 44432-8303
Country : US
Telephone Number : 330-424-9591
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2014
Last Update Date : 01/28/2014

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Directions to “ JENNIFER MCDONOUGH ” Practice Location

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