Healthcare Provider Details

I. General information

NPI: 1699859199
Provider Name (Legal Business Name): CATHERINE A. MCDONALD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 N POKEGAMA AVE STE 16
GRAND RAPIDS MN
55744-2684
US

IV. Provider business mailing address

412 N POKEGAMA AVE STE 16
GRAND RAPIDS MN
55744-2684
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-3390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7789
License Number StateMN

VIII. Authorized Official

Name: CATHERINE A MCDONALD
Title or Position: OWNER
Credential: LICSW
Phone: 218-326-3390