MEDICARE: BRANDI LEIGH SOHN LMSW

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	101692	IA

General Provider Information

NPI Number	:	1093327264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI LEIGH SOHN LMSW

Provider Business Mailing Address
First Line	:	927 N 2ND ST STE B
Second Line	:
City	:	CLINTON
State	:	IA
Zip	:	52732-3750
Country	:	US
Telephone Number	:	563-221-1849
Fax Number	:	866-496-4073

Provider Business Practice Location Address
First Line	:	1770 CENTRAL AVE
Second Line	:
City	:	DUBUQUE
State	:	IA
Zip	:	52001-3607
Country	:	US
Telephone Number	:	563-265-8694
Fax Number	:	866-496-4073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	08/19/2020

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