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General NPI Number Information
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NPI Number | 1922039791
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH KRATZ LISW
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 601 HIGHWAY 6 W
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City | IOWA CITY
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State | IA
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Zip | 52246-2292
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Country | US
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Telephone | 319-351-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 1705 10TH ST
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City | CORALVILLE
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State | IA
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Zip | 52241-1317
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Country | US
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Telephone | 319-351-0167
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 01189
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License Number State | IA
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