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General NPI Number Information
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NPI Number | 1114256161
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Entity Type | Organization
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Legal Business Name | CHILDREN'S CARE HOSPITAL AND SCHOOL DBA LIFESCAPE
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Dates
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Enumeration Date | 12/21/2009
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 2524 GLENN AVE
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City | SIOUX CITY
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State | IA
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Zip | 51106-2768
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Country | US
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Telephone | 712-226-2253
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Fax |
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Provider Business Mailing Address
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Address Line | 2524 GLENN AVE
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City | SIOUX CITY
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State | IA
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Zip | 51106
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Country | US
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Telephone | 712-226-2253
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OUTPATIENT OPERATIONS
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Name | MRS. AMY M JENSEN
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Credential |
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Telephone | 605-444-9711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 01736
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 004071
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 001932
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License Number State | IA
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