1730599341 NPI number — MRS. WINDY J DISALVO LMSW, PLMHP (FOR NEB

Table of content: MRS. WINDY J DISALVO LMSW, PLMHP (FOR NEB (NPI 1730599341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730599341 NPI number — MRS. WINDY J DISALVO LMSW, PLMHP (FOR NEB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DISALVO
Provider First Name:
WINDY
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW, PLMHP (FOR NEB
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROTTENBUCHER
Provider Other First Name:
WINDY
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW, PLMHP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730599341
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8-C
Provider Second Line Business Mailing Address:
NORTH 6TH AND AVE E.
Provider Business Mailing Address City Name:
COUNCIL BLUFFS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51502-3008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-322-3700
Provider Business Mailing Address Fax Number:
712-325-8200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
719 MILL ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COUNCIL BLUFFS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51502-3008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-326-5906
Provider Business Practice Location Address Fax Number:
712-323-6968
Provider Enumeration Date:
05/05/2014

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: 101YM0800X , with the licence number:  10235 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 075547 , 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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