Provider Demographics
NPI:1306044995
Name:MCGILL, MAGGIE
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:MCGILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 MEREDITH DR
Mailing Address - Street 2:STE. B
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-2334
Mailing Address - Country:US
Mailing Address - Phone:515-334-9484
Mailing Address - Fax:515-334-9498
Practice Address - Street 1:5525 MEREDITH DR
Practice Address - Street 2:STE. B
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-2334
Practice Address - Country:US
Practice Address - Phone:515-334-9484
Practice Address - Fax:515-334-9498
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006924104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker