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Organization

MHC CHILD PROTECTION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. RONALD J ROBERSON (CFO)
(712) 279-5850
Entity
Organization

Contact information

Practice address
801 5TH ST, SIOUX CITY, IA 51101-1394
(712) 279-2548
Mailing address
PO BOX 1463, SIOUX CITY, IA 51102-1463
(712) 279-2263

Taxonomy

Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0290858
IA
01
29085
WELLMARK
IA
Enumeration date
01/12/2006
Last updated
08/22/2020
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