MEDICARE: WAVES HEALING THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1053097113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAVES HEALING THERAPY, LLC

Provider Business Mailing Address
First Line	:	217 SUMMIT ST
Second Line	:
City	:	EARLVILLE
State	:	IA
Zip	:	52041-2562
Country	:	US
Telephone Number	:	563-608-4281
Fax Number	:	563-822-1052

Provider Business Practice Location Address
First Line	:	105 E BUTLER ST
Second Line	:
City	:	MANCHESTER
State	:	IA
Zip	:	52057-1606
Country	:	US
Telephone Number	:	563-929-6571
Fax Number	:

Authorized Official
Title or Position	:	LISCENCED INDEPENDENT SOCIAL WORKER
Name	:	STEFANIE DINGBAUM
Credential	:	LISW
Telephone Number	:	563-608-4281

Provider Enumeration Date	:	06/23/2023
Last Update Date	:	01/29/2024

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