| NPI | 1831494228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY JAY VANGORKOM Owner 319-531-1158 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 06248) |
| Enumeration Date | 2011-01-17 |
| Last Update Date | 2012-08-20 |