Provider Demographics
NPI:1861508020
Name:MCDONOUGH, VIRGINIA (MSW)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:MCDONOUGH
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 1:1770 N PARK PL #107
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563
Mailing Address - Country:US
Mailing Address - Phone:630-355-7055
Mailing Address - Fax:630-427-0565
Practice Address - Street 1:1770 N PARK PL #107
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:630-355-7055
Practice Address - Fax:630-427-0565
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490037621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216495Medicare PIN