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Individual

MS. MARY LOUISE BLANKENBURG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LISW

Contact information

Practice address
20 S VAN BUREN ST, IOWA CITY, IA 52240-1821
(319) 400-2268
Mailing address
PO BOX 1073, IOWA CITY, IA 52244-1073
(319) 400-2268
(319) 354-1679

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
01283
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0272708
IA
01
23547
WELLMARK/BCBS
IA
05
250553000
IA
Enumeration date
07/27/2006
Last updated
07/09/2007
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