MEDICARE: MRS. AMY LYNETTE WITHAM MSW

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
1	104100000X	Social Worker	127428	IA

General Provider Information

NPI Number	:	1598938573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY LYNETTE WITHAM MSW

Provider Business Mailing Address
First Line	:	1661 N 30TH ST
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-7941
Country	:	US
Telephone Number	:	785-230-4130
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 KENYON RD
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-5787
Country	:	US
Telephone Number	:	515-955-7171
Fax Number	:	515-573-7898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	03/17/2026

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