Provider Demographics
NPI:1225129554
Name:MCMASTER, MILDRED ROSALIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MILDRED
Middle Name:ROSALIE
Last Name:MCMASTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 W 25TH ST
Mailing Address - Street 2:SUITE 0
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-8531
Mailing Address - Country:US
Mailing Address - Phone:785-841-6446
Mailing Address - Fax:
Practice Address - Street 1:2201 W 25TH ST
Practice Address - Street 2:SUITE 0
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2957
Practice Address - Country:US
Practice Address - Phone:785-841-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0883103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS041681Medicare ID - Type Unspecified