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NPI Code Detail

MEDICARE: CROSSWALK COUNSELING CENTER LLC

MEDICARE: CROSSWALK COUNSELING CENTER LLC
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 Worker007084IA

General Provider Information

NPI Number : 1295105039
Entity Type Code : Organization
Provider Name (Legal Business Name) : CROSSWALK COUNSELING CENTER LLC
Provider Business Mailing Address
First Line : 2550 MIDDLE ROAD
Second Line : SUITE 300
City : BETTENDORF
State : IA
Zip : 52722-3287
Country : US
Telephone Number : 319-230-8018
Fax Number : 563-445-2308
Provider Business Practice Location Address
First Line : 2550 MIDDLE ROAD
Second Line : SUITE 300
City : BETTENDORF
State : IA
Zip : 52722-3287
Country : US
Telephone Number : 319-230-8018
Fax Number : 563-445-2308
Authorized Official
Title or Position : SOLE PROPRIETOR
Name : LORI ANN PEDERSEN
Credential : LISW, MSW, MAPC
Telephone Number : 319-230-8018
Provider Enumeration Date : 10/06/2015
Last Update Date : 10/06/2015

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