Healthcare Provider Details

I. General information

NPI: 1326384678
Provider Name (Legal Business Name): REBECCA MCDONALD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4495 HALE PKWY STE 2020
DENVER CO
80220-6210
US

IV. Provider business mailing address

PO BOX 856
ANTIOCH IL
60002-0856
US

V. Phone/Fax

Practice location:
  • Phone: 847-903-5604
  • Fax: 224-788-5112
Mailing address:
  • Phone: 847-903-5604
  • Fax: 244-788-5112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1749
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: