Healthcare Provider Details

I. General information

NPI: 1124682059
Provider Name (Legal Business Name): BOBBY JO SALM MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 COURT AVE
MARENGO IA
52301-1439
US

IV. Provider business mailing address

513 REDBIRD RUN
TIFFIN IA
52340-9309
US

V. Phone/Fax

Practice location:
  • Phone: 319-361-6529
  • Fax:
Mailing address:
  • Phone: 319-330-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number095401
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: