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General NPI Number Information
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NPI Number | 1699398917
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Entity Type | Organization
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Legal Business Name | RICHARD LC CORFMAN
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Dates
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Enumeration Date | 05/20/2020
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 2600 DODGE ST STE D4, UNIT 25
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City | DUBUQUE
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State | IA
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Zip | 52003-7161
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Country | US
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Telephone | 563-513-5908
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Fax | 563-588-3834
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Provider Business Mailing Address
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Address Line | 2600 DODGE ST STE D4, UNIT 25
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City | DUBUQUE
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State | IA
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Zip | 52003-7161
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Country | US
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Telephone | 563-513-5908
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Fax | 563-588-3834
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Authorized Official
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Title or Position | OWNER OF ENTITY
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Name | RICHARD LC CORFMAN
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Credential |
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Telephone | 563-513-5908
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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 |
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License Number State |
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