Provider Demographics
NPI:1235141714
Name:MCDONALD, SHIRLEY P (MSW)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:P
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 RICH RD
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1629
Mailing Address - Country:US
Mailing Address - Phone:708-747-3999
Mailing Address - Fax:708-747-3941
Practice Address - Street 1:230 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-2098
Practice Address - Country:US
Practice Address - Phone:708-269-3999
Practice Address - Fax:708-747-3941
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical