Healthcare Provider Details

I. General information

NPI: 1407177728
Provider Name (Legal Business Name): WENDY CHRISTINE FAHLGREN L.M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 01/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 PENNSYLVANIA AVE
OTTUMWA IA
52501-2108
US

IV. Provider business mailing address

1009 PENNSYLVANIA AVE
OTTUMWA IA
52501-2108
US

V. Phone/Fax

Practice location:
  • Phone: 641-683-4300
  • Fax:
Mailing address:
  • Phone: 641-683-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number007528
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: