Provider Demographics
NPI:1871629725
Name:MCLALLEN, CATHERINE TINSLEY (EDS)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:TINSLEY
Last Name:MCLALLEN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 S BLUFF BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-6549
Mailing Address - Country:US
Mailing Address - Phone:563-243-6054
Mailing Address - Fax:563-243-6828
Practice Address - Street 1:1523 S BLUFF BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-6549
Practice Address - Country:US
Practice Address - Phone:563-243-6054
Practice Address - Fax:563-243-6828
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA358946103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA23379Medicare UPIN