Healthcare Provider Details

I. General information

NPI: 1215854997
Provider Name (Legal Business Name): CARLY ANN DALBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 2ND ST NE
WAVERLY IA
50677-1762
US

IV. Provider business mailing address

124 2ND ST NE
WAVERLY IA
50677-1762
US

V. Phone/Fax

Practice location:
  • Phone: 319-344-4994
  • Fax:
Mailing address:
  • Phone: 319-344-4994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number139339
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: