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General NPI Number Information
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NPI Number | 1992034755
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Entity Type | Individual
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Provider Name | TANA ASHLEY FOURDYCE LISW
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Gender | Female
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Dates
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Enumeration Date | 12/08/2009
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 810 MAIN ST
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City | MUSCATINE
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State | IA
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Zip | 52761-1848
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Country | US
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Telephone | 563-320-7050
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Fax |
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Provider Business Mailing Address
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Address Line | 1706 BRADY ST STE 206
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City | DAVENPORT
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State | IA
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Zip | 52803-4708
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Country | US
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Telephone | 563-508-5205
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Fax | 563-424-5453
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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 | 006963
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License Number State | IA
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