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NPI Code Detail

MEDICARE: MRS. KATIE LISA MOORBERG LMSW

MEDICARE: MRS. KATIE LISA MOORBERG 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 Worker083307IA

General Provider Information

NPI Number : 1710729900
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATIE LISA MOORBERG LMSW
Provider Business Mailing Address
First Line : 1850 ROYAL AVE
Second Line :
City : SPIRIT LAKE
State : IA
Zip : 51360-1190
Country : US
Telephone Number : 712-336-6400
Fax Number : 612-725-1098
Provider Business Practice Location Address
First Line : 1850 ROYAL AVE
Second Line :
City : SPIRIT LAKE
State : IA
Zip : 51360-1190
Country : US
Telephone Number : 712-336-6400
Fax Number : 612-725-1098
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2024
Last Update Date : 06/10/2024

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