Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 080579 | IA |
NPI | 1003261868 |
---|---|
Provider Name | Valerie Hannenberg |
First Address | Cedar Rapids, IA 52403 |
Second Address | Cedar Falls, IA 50613-2056 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2016 |
Last Update Date | 07/10/2019 |