Healthcare Provider Details

I. General information

NPI: 1073562914
Provider Name (Legal Business Name): SANDRA K PELZER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 BROADWAY ST
EMMETSBURG IA
50536-2419
US

IV. Provider business mailing address

201 E 11TH ST
SPENCER IA
51301-4436
US

V. Phone/Fax

Practice location:
  • Phone: 712-852-2922
  • Fax: 712-852-4198
Mailing address:
  • Phone: 712-262-2922
  • Fax: 712-262-3826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number01827
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: