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General NPI Number Information
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NPI Number | 1356743009
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Entity Type | Organization
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Legal Business Name | MARY K CORBIN
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 826 RUNDELL ST
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City | IOWA CITY
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State | IA
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Zip | 52240-6254
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Country | US
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Telephone | 319-430-3882
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Fax |
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Provider Business Mailing Address
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Address Line | 826 RUNDELL ST
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City | IOWA CITY
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State | IA
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Zip | 52240-6254
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Country | US
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Telephone | 319-430-3882
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORK SPECIALIST I
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Name | MRS. MARY KAY CORBIN
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Credential | LISW
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Telephone | 319-430-3882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 03129
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License Number State | IA
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