Healthcare Provider Details

I. General information

NPI: 1396711768
Provider Name (Legal Business Name): SOUTHERN IOWA ECONOMIC DEVELOPMENT ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 09/18/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W. MAIN ST
OTTUMWA IA
52501
US

IV. Provider business mailing address

PO BOX 658
OTTUMWA IA
52501
US

V. Phone/Fax

Practice location:
  • Phone: 641-683-6747
  • Fax: 641-683-6317
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. SUZETTE VAN VARK
Title or Position: UNIT DIRECTOR
Credential:
Phone: 641-683-6747