Healthcare Provider Details

I. General information

NPI: 1184311557
Provider Name (Legal Business Name): KRISTINE NICHOLS-HUBER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINE ZANK

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N PERRY ST
DAVENPORT IA
52801-1617
US

IV. Provider business mailing address

601 US-6 W
IOWA CITY IA
52246
US

V. Phone/Fax

Practice location:
  • Phone: 563-328-5800
  • Fax:
Mailing address:
  • Phone: 319-338-0581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.030509
License Number StateIL

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: