Provider Demographics
NPI:1912603903
Name:MACDOUGALL, CHRISTINE M
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:MACDOUGALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SHIPPEE RD
Mailing Address - Street 2:
Mailing Address - City:LENA
Mailing Address - State:IL
Mailing Address - Zip Code:61048-9658
Mailing Address - Country:US
Mailing Address - Phone:815-266-9362
Mailing Address - Fax:
Practice Address - Street 1:205 SHIPPEE RD
Practice Address - Street 2:
Practice Address - City:LENA
Practice Address - State:IL
Practice Address - Zip Code:61048-9658
Practice Address - Country:US
Practice Address - Phone:815-266-9362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist