Healthcare Provider Details

I. General information

NPI: 1750834727
Provider Name (Legal Business Name): AMY C KUEHL, LISW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 DUFF AVE SUITE 100
AMES IA
50010-6391
US

IV. Provider business mailing address

511 DUFF AVE SUITE 100
AMES IA
50010-6391
US

V. Phone/Fax

Practice location:
  • Phone: 515-520-1896
  • Fax: 515-292-5044
Mailing address:
  • Phone: 515-520-1896
  • Fax: 515-292-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number06805
License Number StateIA

VIII. Authorized Official

Name: AMY KUEHL
Title or Position: OWNER
Credential: LISW
Phone: 515-520-1896