Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 095607 | IA |
NPI | 1003474651 |
---|---|
Provider Name | Michelle Renee Mattingly |
First Address | Letts, IA 52754-9219 |
Second Address | Muscatine, IA 52761-3836 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2019 |
Last Update Date | 30/05/2019 |