Provider Demographics
NPI:1699363218
Name:MCDONALD, ANDRE JEROME I (CHT)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:JEROME
Last Name:MCDONALD
Suffix:I
Gender:M
Credentials:CHT
Other - Prefix:DR
Other - First Name:ANDRE
Other - Middle Name:J
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHT
Mailing Address - Street 1:484 CLAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-2026
Mailing Address - Country:US
Mailing Address - Phone:715-560-5325
Mailing Address - Fax:
Practice Address - Street 1:484 CLAYTON AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-2026
Practice Address - Country:US
Practice Address - Phone:715-560-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst