Healthcare Provider Details

I. General information

NPI: 1356509830
Provider Name (Legal Business Name): SUSAN JEAN MARVIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E CALL ST
ALGONA IA
50511-2444
US

IV. Provider business mailing address

PO BOX 474
HUMBOLDT IA
50548-0474
US

V. Phone/Fax

Practice location:
  • Phone: 515-295-3334
  • Fax: 515-295-3337
Mailing address:
  • Phone: 515-295-3334
  • Fax: 515-295-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SUSAN MARVIN
Title or Position: OWNER
Credential: LISW
Phone: 515-295-3334