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NPI Code Detail

MEDICARE: MR. DAVID ROSS DONALDSON ACSW,LCSW

MEDICARE: MR. DAVID ROSS DONALDSON ACSW,LCSW
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
1104100000XSocial WorkerIL

General Provider Information

NPI Number : 1629006960
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID ROSS DONALDSON ACSW,LCSW
Provider Business Mailing Address
First Line : 540 HINMAN AVE
Second Line : UNIT 3
City : EVANSTON
State : IL
Zip : 60202-4613
Country : US
Telephone Number : 847-491-1663
Fax Number :
Provider Business Practice Location Address
First Line : 3003 W TOUHY AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60645-2833
Country : US
Telephone Number : 773-508-1129
Fax Number : 773-262-7084
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2006
Last Update Date : 07/08/2007

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