| NPI | 1578560256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE BOESENBERG Executive Director 319-390-4611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IA 1221) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2024-05-28 |