Basic Information
| Provider Information | |||||||||
| NPI: | 1578979530 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDONALD | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1011 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503157567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5155771934 | ||||||||
| FaxNumber: | 5152889109 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503142329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152881981 | ||||||||
| FaxNumber: | 5152889109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2014 | ||||||||
| LastUpdateDate: | 07/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 072638 | IA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.