Provider Demographics
NPI:1972072338
Name:MCDONALD, KAREY
Entity type:Individual
Prefix:
First Name:KAREY
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREY
Other - Middle Name:
Other - Last Name:BRUNNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1105 W RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-1322
Mailing Address - Country:US
Mailing Address - Phone:605-271-2690
Mailing Address - Fax:
Practice Address - Street 1:945 PENDELL BLVD
Practice Address - Street 2:
Practice Address - City:MILLS
Practice Address - State:WY
Practice Address - Zip Code:82644
Practice Address - Country:US
Practice Address - Phone:605-271-2690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician