Healthcare Provider Details

I. General information

NPI: 1477237931
Provider Name (Legal Business Name): THE CENTER FOR SELF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 1ST AVE SE STE 310
CEDAR RAPIDS IA
52402-3221
US

IV. Provider business mailing address

2135 LINCOLNSHIRE DR SE
CEDAR RAPIDS IA
52403-1656
US

V. Phone/Fax

Practice location:
  • Phone: 319-435-1677
  • Fax: 319-409-8275
Mailing address:
  • Phone: 319-435-1677
  • Fax: 319-409-8275

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: SARAH ELIZABETH BLADER
Title or Position: PRESIDENT, THERAPIST
Credential: MSW, LISW
Phone: 319-435-1677