Individual
KATRINA LYNN FULTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
5400 KIRKWOOD BLVD SW, CEDAR RAPIDS, IA 52404-5216
(319) 364-0259
Mailing address
716 19TH AVE, CORALVILLE, IA 52241-1616
(319) 331-5711
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
007282
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007282
LISW LICENSE
IA
Enumeration date
11/29/2009
Last updated
01/02/2019
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