Individual
MARY HENDERSHOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.I.S.W.
Contact information
Practice address
2435 KIMBERLY RD, STE 165S, BETTENDORF, IA 52722-3591
(563) 362-2848
(563) 888-5160
Mailing address
2435 KIMBERLY RD., #165 SOUTH, BETTENDORF, IA 52722
(563) 362-2848
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
05287
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0283507
—
IA
01
—
218643
HEALTH ALLIANCE MEDICARE
IA
01
—
I18118
MEDICARE ID
IA
Enumeration date
10/03/2006
Last updated
07/19/2019
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