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General NPI Number Information
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NPI Number | 1265804082
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Entity Type | Individual
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Provider Name | KATRINA (TINA) K WEDERQUIST ZANDERS MS, LMSW
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Gender | Female
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 409 1/2 W 7TH CATHOLIC CHARITIES
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City | CARROLL
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State | IA
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Zip | 51401
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Country | US
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Telephone | 712-792-9597
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Fax | 712-792-6146
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Provider Business Mailing Address
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Address Line | PO BOX 13 409 1/2 W 7TH CATHOLIC CHARITIES
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City | CARROLL
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State | IA
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Zip | 51401
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Country | US
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Telephone | 712-792-9597
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Fax | 712-792-6146
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW02963
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License Number State | IA
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