Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1013561406 |
---|---|
Provider Name | Dr. Grand Mcdonald |
First Address | Chicago, IL 60643-2010 |
Second Address | Chicago, IL 60611-2595 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2019 |
Last Update Date | 24/07/2019 |