Individual
MARY DOHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
505 5TH AVE, DES MOINES, IA 50309-2324
(515) 471-2319
Mailing address
7702 SW 10TH PL, DES MOINES, IA 50315-6703
(815) 299-2126
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
107516
IA
Other
Enumeration date
06/25/2021
Last updated
06/25/2021
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