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NPI Code Detail

MEDICARE: AMANDA GALLOGLY

MEDICARE: AMANDA GALLOGLY
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
1104100000XSocial Worker007478IA

General Provider Information

NPI Number : 1194069757
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA GALLOGLY
Provider Business Mailing Address
First Line : 5400 KIRKWOOD BLVD SW
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52404-5216
Country : US
Telephone Number : 319-364-0259
Fax Number :
Provider Business Practice Location Address
First Line : 1916 WATERFRONT DR
Second Line :
City : IOWA CITY
State : IA
Zip : 52240-4416
Country : US
Telephone Number : 319-337-4523
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2012
Last Update Date : 06/14/2013

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Directions to “ AMANDA GALLOGLY ” Practice Location

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