Healthcare Provider Details

I. General information

NPI: 1487689501
Provider Name (Legal Business Name): PAT L. LOWENBERG L.I.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

505 E TAYLOR ST
CRESTON IA
50801-4057
US

IV. Provider business mailing address

PO BOX 361
AFTON IA
50830-0361
US

V. Phone/Fax

Practice location:
  • Phone: 641-782-7212
  • Fax: 641-347-5060
Mailing address:
  • Phone: 641-347-5060
  • Fax: 641-347-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number01250
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: