Individual
MICHAEL RAE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
1221 S GEAR AVE, WEST BURLINGTON, IA 52655-1681
(319) 524-3560
(319) 865-3110
Mailing address
2416 340TH ST, KEOKUK, IA 52632-9539
(319) 524-3560
(319) 865-3110
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
02700
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0268474
—
IA
01
—
11098
MIDLANDS
IA
01
—
463086
VALUE OPTIONS
IA
01
—
59126
WELLMARK
IA
01
—
800013924
RAILROAD MEDICARE
IA
Enumeration date
08/05/2006
Last updated
03/31/2021
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