Individual
MARK ALAN DE RUYTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
116 E. 11TH ST., SPENCER, IA 51301
(712) 264-6048
Mailing address
116 E. 11TH ST., SPENCER, IA 51301
(712) 264-6048
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
02160
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02160
SOCIAL WORK LICENSE
IA
Enumeration date
08/29/2013
Last updated
08/29/2013
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