MEDICARE: CATHERINE ANN MCDERMOTT M.S,W,

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	1041C0700X	Clinical Social Worker	01672	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	37315	OTHER	IA	WELLMARK BC/BS PROV. #

General Provider Information

NPI Number	:	1144292871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE ANN MCDERMOTT M.S,W,

Provider Business Mailing Address
First Line	:	2728 ASBURY RD
Second Line	:	SUITE 777
City	:	DUBUQUE
State	:	IA
Zip	:	52001-2971
Country	:	US
Telephone Number	:	563-556-9642
Fax Number	:	563-557-5030

Provider Business Practice Location Address
First Line	:	2728 ASBURY RD
Second Line	:	SUITE 777
City	:	DUBUQUE
State	:	IA
Zip	:	52001-2971
Country	:	US
Telephone Number	:	563-556-9642
Fax Number	:	563-557-5030

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	07/08/2007

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