Healthcare Provider Details

I. General information

NPI: 1548178213
Provider Name (Legal Business Name): OLIVIA K D'AMICO-PANKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 BLAIRS FERRY RD
MARION IA
52302-3157
US

IV. Provider business mailing address

1655 BLAIRS FERRY RD
MARION IA
52302-3157
US

V. Phone/Fax

Practice location:
  • Phone: 319-261-2292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number138767
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: