Provider Demographics
NPI:1891958120
Name:MCNAUGHT, DEANNA MAE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:MAE
Last Name:MCNAUGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E MILLER RD
Mailing Address - Street 2:
Mailing Address - City:EDELSTEIN
Mailing Address - State:IL
Mailing Address - Zip Code:61526-9740
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1007 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:IL
Practice Address - Zip Code:61523-1658
Practice Address - Country:US
Practice Address - Phone:309-740-1803
Practice Address - Fax:309-740-1775
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490082401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK53517Medicare UPIN