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General NPI Number Information
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NPI Number | 1003840117
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Entity Type | Individual
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Provider Name | COLLEEN A MELLERUP LISW
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Gender | Female
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/04/2013
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Provider Practice Location Address
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Address Line | 1150 5TH ST SUITE #267
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City | CORALVILLE
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State | IA
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Zip | 52241-2932
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Country | US
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Telephone | 319-341-5933
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Fax |
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Provider Business Mailing Address
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Address Line | 1150 5TH ST SUITE #267
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City | CORALVILLE
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State | IA
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Zip | 52241-2932
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Country | US
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Telephone | 319-341-5933
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 995
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License Number State | IA
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