Healthcare Provider Details

I. General information

NPI: 1003002114
Provider Name (Legal Business Name): BARBARA JEAN PATSCHKE ISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 A AVE NE
CEDAR RAPIDS IA
52402-5057
US

IV. Provider business mailing address

PO BOX 337
CEDAR RAPIDS IA
52406-0337
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-7091
  • Fax: 319-369-7071
Mailing address:
  • Phone: 319-369-7091
  • Fax: 319-369-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00933
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: