Healthcare Provider Details

I. General information

NPI: 1275645947
Provider Name (Legal Business Name): FREDERICK FOLGER MACDONALD PHD MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8036 MOORSBRIDGE ROAD STE 2
PORTAGE MI
49024-4417
US

IV. Provider business mailing address

PO BOX 2585
PORTAGE MI
49081-2585
US

V. Phone/Fax

Practice location:
  • Phone: 269-327-1438
  • Fax: 269-327-6454
Mailing address:
  • Phone: 269-381-0150
  • Fax: 269-373-4720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: