Provider Demographics
NPI:1104814839
Name:MCDONALD, ANN G (LISW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:G
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 LINCOLN RD
Mailing Address - Street 2:STE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4190
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:4455 E 56TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2995
Practice Address - Country:US
Practice Address - Phone:563-355-2577
Practice Address - Fax:563-355-4015
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA009881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1414722Medicaid
IA37650OtherWELLMARK HEALTH PLAN
IA01M3OtherJOHN DEERE HEALTH PLAN
IA37650OtherWELLMARK HEALTH PLAN
IAI14267Medicare ID - Type UnspecifiedMEDICARE NUMBER