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NPI Code Detail

MEDICARE: TINA RECKER LMSW

MEDICARE: TINA RECKER LMSW
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
1104100000XSocial Worker117584IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1117584OTHERIASTATE LICENSE

General Provider Information

NPI Number : 1144911793
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA RECKER LMSW
Provider Business Mailing Address
First Line : 1789 250TH AVE
Second Line :
City : EARLVILLE
State : IA
Zip : 52041-8646
Country : US
Telephone Number : 319-210-0314
Fax Number :
Provider Business Practice Location Address
First Line : 721 S 5TH ST
Second Line :
City : MANCHESTER
State : IA
Zip : 52057-2048
Country : US
Telephone Number : 563-927-6700
Fax Number : 563-627-6703
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2023
Last Update Date : 05/16/2023

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Directions to “ TINA RECKER LMSW” Practice Location

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