1073522306 NPI number — DR. HARRIET A PHELPS PSY.D, LISW

Table of content: DR. HARRIET A PHELPS PSY.D, LISW (NPI 1073522306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073522306 NPI number — DR. HARRIET A PHELPS PSY.D, LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHELPS
Provider First Name:
HARRIET
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D, LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073522306
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2783
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52809-2783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-381-8088
Provider Business Mailing Address Fax Number:
563-381-8077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
718 BRIDGE AVE
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52803-5620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-381-8088
Provider Business Practice Location Address Fax Number:
563-381-8077
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  00851 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 216358 . This is a "IOWA HEALTH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 486768000 . This is a "MAGELLAN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0457481 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1073522306 . This is a "TRICARE/CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 396294 . This is a "VALUE OPTIONS RAILROAD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 36005 . This is a "WELLMARK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 238252 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 246562 . This is a "COMPSYCH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 800013870 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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