Provider Demographics
NPI:1144292871
Name:MCDERMOTT, CATHERINE ANN (MS,W,)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:MS,W,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 ASBURY RD
Mailing Address - Street 2:SUITE 777
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-2971
Mailing Address - Country:US
Mailing Address - Phone:563-556-9642
Mailing Address - Fax:563-557-5030
Practice Address - Street 1:2728 ASBURY RD
Practice Address - Street 2:SUITE 777
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-2971
Practice Address - Country:US
Practice Address - Phone:563-556-9642
Practice Address - Fax:563-557-5030
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA016721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA37315OtherWELLMARK BC/BS PROV. #