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NPI Code Detail

MEDICARE: MRS. TERESA D MCDONALD LSCSW

MEDICARE:  MRS. TERESA D MCDONALD  LSCSW
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
11041C0700XClinical Social Worker3598KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1829998OTHERKSBLUE CROSS BLUE SHIELD
213550OTHERKSPREFERRED HEALTH SYSTEMS

General Provider Information

NPI Number : 1619914132
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TERESA D MCDONALD LSCSW
Provider Business Mailing Address
First Line : 6525 E MAINSGATE RD
Second Line :
City : WICHITA
State : KS
Zip : 67226-1062
Country : US
Telephone Number : 316-461-7923
Fax Number : 316-260-7045
Provider Business Practice Location Address
First Line : 6525 E MAINSGATE RD
Second Line :
City : WICHITA
State : KS
Zip : 67226-1062
Country : US
Telephone Number : 316-461-7923
Fax Number : 316-260-7045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2006
Last Update Date : 10/18/2016

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1497967061 — MS. MELISSA THOMPSON-BECK LMFT
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Directions to “ MRS. TERESA D MCDONALD LSCSW” Practice Location

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