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NPI Code Detail

MEDICARE: KIMBERLY JOAN DEVRIES LISW

MEDICARE: KIMBERLY JOAN DEVRIES LISW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker01432IA

General Provider Information

NPI Number : 1003877291
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY JOAN DEVRIES LISW
Provider Business Mailing Address
First Line : PO BOX 1197
Second Line :
City : SIOUX CITY
State : IA
Zip : 51102-1197
Country : US
Telephone Number : 712-293-4700
Fax Number : 712-293-4805
Provider Business Practice Location Address
First Line : 2101 COURT ST
Second Line :
City : SIOUX CITY
State : IA
Zip : 51104-3243
Country : US
Telephone Number : 712-293-4700
Fax Number : 712-293-4805
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2006
Last Update Date : 07/08/2007

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Directions to “ KIMBERLY JOAN DEVRIES LISW” Practice Location

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