1265804082 NPI number — MRS. KATRINA (TINA) K WEDERQUIST ZANDERS MS, LMSW

Table of content: MRS. KATRINA (TINA) K WEDERQUIST ZANDERS MS, LMSW (NPI 1265804082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265804082 NPI number — MRS. KATRINA (TINA) K WEDERQUIST ZANDERS MS, LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEDERQUIST ZANDERS
Provider First Name:
KATRINA (TINA)
Provider Middle Name:
K
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZANDERS
Provider Other First Name:
TINA
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LMSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1265804082
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13
Provider Second Line Business Mailing Address:
409 1/2 W 7TH CATHOLIC CHARITIES
Provider Business Mailing Address City Name:
CARROLL
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-792-9597
Provider Business Mailing Address Fax Number:
712-792-6146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 1/2 W 7TH
Provider Second Line Business Practice Location Address:
CATHOLIC CHARITIES
Provider Business Practice Location Address City Name:
CARROLL
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-792-9597
Provider Business Practice Location Address Fax Number:
712-792-6146
Provider Enumeration Date:
10/21/2015

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: 104100000X , with the licence number:  LMSW02963 , 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)





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