Active NPI
Avie Gail Socorro Dela Cerna McDonald, SLP-CCC
- Speech-Language Pathologist
- Queen Creek, AZ
National Provider Identifier
1396223293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 5279340
- Practice address
- 1560 W Crape Rd
Queen Creek, AZ 85140-7818 - Phone
- (480) 438-9341
- NPI assigned
- Aug 2, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 5279340 | AZ | Primary |
Addresses
Primary practice location
1560 W Crape Rd
Queen Creek, AZ 85140-7818
Mailing address
1560 W Crape Rd
Guadalupe
Queen Creek, CEBU CITY 85140
PH
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5279340 | AZ | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707177600000",
"number": "1396223293",
"addresses": [
{
"country_code": "PH",
"country_name": "Philippines",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "1560 W CRAPE RD",
"address_2": "GUADALUPE",
"city": "QUEEN CREEK",
"state": "CEBU CITY",
"postal_code": "85140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1560 W CRAPE RD",
"city": "QUEEN CREEK",
"state": "AZ",
"postal_code": "851407818",
"telephone_number": "480-438-9341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONALD",
"first_name": "AVIE GAIL SOCORRO",
"middle_name": "DELA CERNA",
"credential": "SLP-CCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-08-02",
"last_updated": "2024-02-06",
"certification_date": "2024-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AZ",
"license": "5279340",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Queen Creek, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.