Doctor Name: | MRS. PENNY MICHELLE FREEMAN |
NPI Number: | 1013276120 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LISW |
License Number: | 006893 |
Business Practice Address: | 4403 1st Ave Se Ste 309 Cedar Rapids, IA - 524023221 |
Business Phone Number: | 3193620632 |
Business Fax Number: | 3193625206 |
Mailing Address: | 4403 1st Ave Se Ste 309, CEDAR RAPIDS |
State: | IA |
Postal Code: | 524023221 |
Phone Number: | 3193620632 |
Fax Number: | 3193625206 |
NPI Enumeration Date: | 05/09/2012 |
NPI Last Update Date: | 08/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 006893 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |