Healthcare Provider Details

I. General information

NPI: 1750456182
Provider Name (Legal Business Name): KATHLEEN M TERABERRY MSW LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 2ND ST SE SUITE 202
CEDAR RAPIDS IA
52401-1416
US

IV. Provider business mailing address

5400 KIRKWOOD BLVD SW
CEDAR RAPIDS IA
52404
US

V. Phone/Fax

Practice location:
  • Phone: 319-364-4593
  • Fax: 866-266-5895
Mailing address:
  • Phone: 319-364-0259
  • Fax: 866-290-5565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number760
License Number StateIA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: