Healthcare Provider Details

I. General information

NPI: 1508427584
Provider Name (Legal Business Name): REID ANDREW METTERT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 JONES ST STE H
DUBUQUE IA
52001-7615
US

IV. Provider business mailing address

927 N 2ND ST STE B
CLINTON IA
52732-3750
US

V. Phone/Fax

Practice location:
  • Phone: 563-599-1221
  • Fax:
Mailing address:
  • Phone: 877-878-6606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number109884
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: