Healthcare Provider Details

I. General information

NPI: 1710790225
Provider Name (Legal Business Name): LAURA MACDONALD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 W ASPERA BLVD APT 2009
GLENDALE AZ
85308-7924
US

IV. Provider business mailing address

7700 W ASPERA BLVD APT 2009
GLENDALE AZ
85308-7924
US

V. Phone/Fax

Practice location:
  • Phone: 901-734-2731
  • Fax:
Mailing address:
  • Phone: 901-734-2731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23951
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: