Basic Information
Provider Information
NPI: 1003002114
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATSCHKE
FirstName: BARBARA
MiddleName: JEAN
NamePrefix:  
NameSuffix:  
Credential: ISW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 337
Address2:  
City: CEDAR RAPIDS
State: IA
PostalCode: 524060337
CountryCode: US
TelephoneNumber: 3193697091
FaxNumber: 3193697071
Practice Location
Address1: 855 A AVE NE
Address2:  
City: CEDAR RAPIDS
State: IA
PostalCode: 524025057
CountryCode: US
TelephoneNumber: 3193697091
FaxNumber: 3193697071
Other Information
ProviderEnumerationDate: 09/21/2007
LastUpdateDate: 11/27/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X00933IAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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