Provider Demographics
NPI:1275058133
Name:MCDONALD, LAURA A (SW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:A
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-0327
Mailing Address - Country:US
Mailing Address - Phone:740-533-0055
Mailing Address - Fax:740-533-1511
Practice Address - Street 1:424 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1474
Practice Address - Country:US
Practice Address - Phone:740-533-0055
Practice Address - Fax:740-533-1511
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1700681104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2871129Medicaid