Basic Information
Provider Information
NPI: 1033159660
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAAS
FirstName: HOLLY
MiddleName: NICOLE
NamePrefix: MS.
NameSuffix:  
Credential: LMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: KRIENER
OtherFirstName: HOLLY
OtherMiddleName: NICOLE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: LMSW
OtherLastNameType: 1
Mailing Information
Address1: 200 HAWKINS DR
Address2:  
City: IOWA CITY
State: IA
PostalCode: 522421009
CountryCode: US
TelephoneNumber: 3193536314
FaxNumber: 3193537788
Practice Location
Address1: 200 HAWKINS DR
Address2:  
City: IOWA CITY
State: IA
PostalCode: 522421009
CountryCode: US
TelephoneNumber: 3193536314
FaxNumber: 3193537788
Other Information
ProviderEnumerationDate: 06/08/2006
LastUpdateDate: 02/09/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X06176IAN Behavioral Health & Social Service ProvidersSocial Worker 
1041C0700X06176IAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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