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NPI Code Detail

MEDICARE: QUAD-CITIES COUNSELING

MEDICARE: QUAD-CITIES COUNSELING
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 Worker05987IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11912917360OTHERIAINDIVIDUAL NPI

General Provider Information

NPI Number : 1114202660
Entity Type Code : Organization
Provider Name (Legal Business Name) : QUAD-CITIES COUNSELING
Provider Business Mailing Address
First Line : 2550 MIDDLE RD STE 300
Second Line :
City : BETTENDORF
State : IA
Zip : 52722-3287
Country : US
Telephone Number : 563-484-0770
Fax Number : 888-662-3032
Provider Business Practice Location Address
First Line : 2550 MIDDLE RD STE 300
Second Line :
City : BETTENDORF
State : IA
Zip : 52722-3287
Country : US
Telephone Number : 563-484-0770
Fax Number : 888-662-3032
Authorized Official
Title or Position : LISW
Name : MS. DENISE MARIE ADEN
Credential : MSW,LISW
Telephone Number : 563-484-0770
Provider Enumeration Date : 10/17/2011
Last Update Date : 12/06/2013

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