Healthcare Provider Details

I. General information

NPI: 1245487461
Provider Name (Legal Business Name): CHRISTIN WITHERSPOON SQUIER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 04/24/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E STATE ST STE 301
MASON CITY IA
50401-3309
US

IV. Provider business mailing address

50 N EISENHOWER AVE
MASON CITY IA
50401-7340
US

V. Phone/Fax

Practice location:
  • Phone: 641-421-2089
  • Fax: 641-450-0030
Mailing address:
  • Phone: 641-421-8411
  • Fax: 641-421-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06763
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: