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General NPI Number Information
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NPI Number | 1902900400
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Entity Type | Individual
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Provider Name | PETER ALFRED BADAMI LISW
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 312 E ALTA VISTA BEHAVIORAL HEALTH COUNSELING SERVICES
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City | OTTUMWA
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State | IA
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Zip | 52501
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Country | US
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Telephone | 641-684-3138
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Fax | 641-684-3198
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Provider Business Mailing Address
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Address Line | 312 E ALTA VISTA ORHC CLINICS CLINIC BILLING
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City | OTTUMWA
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State | IA
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Zip | 52501
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Country | US
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Telephone | 641-684-3053
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Fax | 641-683-2855
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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 | 00401
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License Number State | IA
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