Provider Demographics
NPI:1548444243
Name:MCDERMOTT, JEAN MARIE (MS, CPRP)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MARIE
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:MS, CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 1ST ST NE
Mailing Address - Street 2:#2
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-1201
Mailing Address - Country:US
Mailing Address - Phone:320-634-0888
Mailing Address - Fax:320-634-0888
Practice Address - Street 1:102 1ST ST NE
Practice Address - Street 2:#2
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-1201
Practice Address - Country:US
Practice Address - Phone:320-634-0888
Practice Address - Fax:320-634-0888
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator