MEDICARE: BRENDA LYNN GERDES 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	1041C0700X	Clinical Social Worker	01664	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100059455001	OTHER	IA	APS HEALTHCARE
2	9357788	OTHER	IA	MULTI PLAN
3	110623	OTHER	IA	HEALTH ALLIANCE
4	38042	OTHER	IA	WELLMARK BCBS
5	39883	OTHER	IA	WELLMARK BCBS

General Provider Information

NPI Number	:	1912042938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA LYNN GERDES LISW

Provider Business Mailing Address
First Line	:	11963 580TH AVE
Second Line	:
City	:	STORY CITY
State	:	IA
Zip	:	50248-8745
Country	:	US
Telephone Number	:	515-979-5661
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 WILLSON AVE
Second Line	:
City	:	WEBSTER CITY
State	:	IA
Zip	:	50595-2215
Country	:	US
Telephone Number	:	515-979-5661
Fax Number	:

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/09/2007

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Directions to “ BRENDA LYNN GERDES LISW” Practice Location

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