Individual
TINA DERRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1063 14TH PL STE A, DES MOINES, IA 50314-1245
(515) 235-5224
Mailing address
1063 14TH PL STE A, DES MOINES, IA 50314-1245
(515) 235-5224
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
075285
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600884423
—
IA
Enumeration date
12/12/2014
Last updated
12/12/2014
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