Healthcare Provider Details

I. General information

NPI: 1568792497
Provider Name (Legal Business Name): KELLI SUE SWITZER LISW, RPT/S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLI SUE WATERBECK

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 COURT AVE
MARENGO IA
52301-1439
US

IV. Provider business mailing address

127 BAILEY PARK RD
WILLIAMSBURG IA
52361-9529
US

V. Phone/Fax

Practice location:
  • Phone: 319-642-3031
  • Fax:
Mailing address:
  • Phone: 319-415-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number007045
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: