| NPI | 1508966557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA S LARSEN-BOLINE Business Manager 319-865-3027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IA 36314) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IA 01393) |
| 106H00000X Marriage & Family Therapist (Licence: IA 00235) | |
| 106H00000X Marriage & Family Therapist (Licence: IA 00240) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2020-08-22 |