Provider Demographics
NPI:1831124122
Name:MCDONALD, LADD DEE (EDD)
Entity Type:Individual
Prefix:DR
First Name:LADD
Middle Name:DEE
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6480 DANIKA CT
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3668
Mailing Address - Country:US
Mailing Address - Phone:530-872-2444
Mailing Address - Fax:530-877-0640
Practice Address - Street 1:1660 HUMBOLDT RD STE 3
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-9199
Practice Address - Country:US
Practice Address - Phone:530-345-2966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4130103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL41300Medicare ID - Type Unspecified
CAR49210Medicare UPIN