Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 06405 | IA |
NPI | 1003107137 |
---|---|
Provider Name | Ms. Tricia M Tentinger |
First Address | West Des Moines, IA 50266-1621 |
Second Address | Urbandale, IA 50322-7908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2011 |
Last Update Date | 24/04/2011 |