Provider Demographics
NPI:1194761759
Name:MCDONOUGH, CAROL A (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13000 S SHAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2035
Mailing Address - Country:US
Mailing Address - Phone:708-732-8024
Mailing Address - Fax:708-827-5068
Practice Address - Street 1:1551 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5440
Practice Address - Country:US
Practice Address - Phone:708-732-8024
Practice Address - Fax:708-827-5068
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL07100559103G00000X
IL071002559103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist