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General NPI Number Information
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NPI Number | 1558899179
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Entity Type | Organization
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Legal Business Name | JULIANNA GONDEK LISW LLC
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Dates
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Enumeration Date | 05/26/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 204 GLENN ST SE STE 2
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City | MOUNT VERNON
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State | IA
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Zip | 52314-1501
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Country | US
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Telephone | 319-777-1092
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Fax | 319-449-3585
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Provider Business Mailing Address
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Address Line | 204 GLENN ST SE STE 2
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City | MOUNT VERNON
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State | IA
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Zip | 52314-1501
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Country | US
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Telephone | 319-777-1092
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Fax | 319-449-3585
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Authorized Official
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Title or Position | OWNER/LISW
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Name | JULIANNA GONDEK
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Credential | MSW
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Telephone | 319-777-1092
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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 | 007320
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License Number State | IA
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