Healthcare Provider Details

I. General information

NPI: 1225400872
Provider Name (Legal Business Name): JENNIFER J POWELL LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER J SCHMUDLACH

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 SAINT FRANCIS DR
WATERLOO IA
50702-5644
US

IV. Provider business mailing address

2750 SAINT FRANCIS DR
WATERLOO IA
50702-5644
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-8922
  • Fax: 319-272-8929
Mailing address:
  • Phone: 319-272-8922
  • Fax: 319-272-8929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number007918
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007918
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: