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NPI Code Detail

MEDICARE: SUSAN K STANNARD LISW

MEDICARE: SUSAN K STANNARD 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 Worker02513IA

General Provider Information

NPI Number : 1548311749
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN K STANNARD LISW
Provider Business Mailing Address
First Line : 800 1ST ST NW
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52405-2713
Country : US
Telephone Number : 319-398-3534
Fax Number : 319-398-3504
Provider Business Practice Location Address
First Line : 1860 COUNTY HOME RD
Second Line :
City : MARION
State : IA
Zip : 52302-9753
Country : US
Telephone Number : 319-398-3534
Fax Number : 319-398-3504
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2007
Last Update Date : 07/08/2007

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Directions to “ SUSAN K STANNARD LISW” Practice Location

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