Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 073419 | IA |
NPI | 1003219445 |
---|---|
Provider Name | Amanda Jo Eason |
First Address | Denison, IA 51442-2026 |
Second Address | Denison, IA 51442-2701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2014 |
Last Update Date | 30/01/2017 |