MEDICARE: MS. KAREN ELIZABETH COMBS LISW

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	101YM0800X	Mental Health Counselor	497	IA
2	1041C0700X	Clinical Social Worker	497	IA

General Provider Information

NPI Number	:	1598052227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN ELIZABETH COMBS LISW

Provider Business Mailing Address
First Line	:	66684 110TH ST
Second Line	:
City	:	MC CALLSBURG
State	:	IA
Zip	:	50154-8014
Country	:	US
Telephone Number	:	515-231-3476
Fax Number	:	641-487-7831

Provider Business Practice Location Address
First Line	:	66684 110TH ST
Second Line	:	66684 110TH STREET
City	:	MC CALLSBURG
State	:	IA
Zip	:	50154-8014
Country	:	US
Telephone Number	:	515-231-3476
Fax Number	:	641-487-7831

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

Provider Enumeration Date	:	07/01/2011
Last Update Date	:	07/01/2011

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