Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 02472 | IA |
NPI | 1003234139 |
---|---|
Provider Name | Patricia J. Mattern Merrick |
First Address | Albia, IA 52531-8502 |
Second Address | Albia, IA 52531-8502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2014 |
Last Update Date | 23/04/2014 |