Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 05133 | IA |
NPI | 1003031949 |
---|---|
Provider Name | Mr. Bob Gene Gaffney |
First Address | Oskaloosa, IA 52577-9698 |
Second Address | Oskaloosa, IA 52577-2827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 08/07/2007 |