Individual
EMMA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
720 KENYON RD, FORT DODGE, IA 50501
(800) 482-8305
(515) 573-7898
Mailing address
720 KENYON RD, FORT DODGE, IA 50501-5759
(800) 482-8305
(515) 573-7898
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
086203
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0159608
—
IA
01
—
07466
WELLMARK BCBS
IA
Enumeration date
04/02/2014
Last updated
07/21/2020
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