Provider Demographics
NPI:1982239406
Name:MCDONALD, AMBER RENEE
Entity type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:RENEE
Last Name:MCDONALD
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 1:14723 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-1618
Mailing Address - Country:US
Mailing Address - Phone:708-305-8991
Mailing Address - Fax:
Practice Address - Street 1:14723 WABASH AVE
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-1618
Practice Address - Country:US
Practice Address - Phone:708-305-8991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician