Provider Demographics
NPI:1912944554
Name:MCDONALD, JAYNE BRICKLEY (MSW,LCSW,AAMFT)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:BRICKLEY
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MSW,LCSW,AAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S 2ND ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-2779
Mailing Address - Country:US
Mailing Address - Phone:217-523-0069
Mailing Address - Fax:217-523-4620
Practice Address - Street 1:901 S 2ND ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-2779
Practice Address - Country:US
Practice Address - Phone:217-523-0069
Practice Address - Fax:217-523-4620
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08405298OtherBLUECROSS/BLLUESHIELD