MEDICARE: CHRISTINA MCDONNELL

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
1	103TC0700X	Clinical Psychologist	789	WY

General Provider Information

NPI Number	:	1114320082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MCDONNELL

Provider Business Mailing Address
First Line	:	1000 E UNIVERSITY AVE DEPT 3415
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82071-2001
Country	:	US
Telephone Number	:	307-223-1847
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 E UNIVERSITY AVE DEPT 3415
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82071-2001
Country	:	US
Telephone Number	:	307-223-1847
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2014
Last Update Date	:	08/20/2025

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