Healthcare Provider Details

I. General information

NPI: 1497924005
Provider Name (Legal Business Name): KRIS METCALF LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 N BROADWAY ST
MT PLEASANT IA
52641-2875
US

IV. Provider business mailing address

1405 N BROADWAY ST
MT PLEASANT IA
52641-2875
US

V. Phone/Fax

Practice location:
  • Phone: 319-385-2910
  • Fax:
Mailing address:
  • Phone: 319-385-2910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLMSW 02718
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: