Healthcare Provider Details

I. General information

NPI: 1013334267
Provider Name (Legal Business Name): KIELY R SUHR NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 S BLUFF BLVD BRIDGEVIEW
CLINTON IA
52732
US

IV. Provider business mailing address

638 S BLUFF BLVD BRIDGEVIEW
CLINTON IA
52732
US

V. Phone/Fax

Practice location:
  • Phone: 563-243-5633
  • Fax:
Mailing address:
  • Phone: 563-243-5633
  • Fax: 563-243-9567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number31255
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: