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NPI Code Detail

MEDICARE: DR. CAROL A MCDONOUGH PH.D.

MEDICARE: DR. CAROL A MCDONOUGH PH.D.
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
1103G00000XClinical Neuropsychologist07100559IL
2103TR0400XRehabilitation Psychologist071002559IL

General Provider Information

NPI Number : 1194761759
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAROL A MCDONOUGH PH.D.
Provider Business Mailing Address
First Line : 13000 S SHAWNEE RD
Second Line :
City : PALOS HEIGHTS
State : IL
Zip : 60463-2035
Country : US
Telephone Number : 708-732-8024
Fax Number : 708-827-5068
Provider Business Practice Location Address
First Line : 1551 HUNTINGTON DR
Second Line :
City : CALUMET CITY
State : IL
Zip : 60409-5440
Country : US
Telephone Number : 708-732-8024
Fax Number : 708-827-5068
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2006
Last Update Date : 11/30/2011

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