Healthcare Provider Details

I. General information

NPI: 1043436264
Provider Name (Legal Business Name): AMY K HULL L.I.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N 14TH ST
DENISON IA
51442-2026
US

IV. Provider business mailing address

20 N 14TH ST
DENISON IA
51442-2026
US

V. Phone/Fax

Practice location:
  • Phone: 712-263-3172
  • Fax: 712-263-5756
Mailing address:
  • Phone: 712-263-3172
  • Fax: 712-263-5756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06075
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: