Individual
JON BACKSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S. ED., LMHC
Contact information
Practice address
1202 W 3RD ST, DAVENPORT, IA 52802-1344
(563) 327-0174
Mailing address
1202 W 3RD ST, DAVENPORT, IA 52802-1344
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
077996
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104307
—
IA
Enumeration date
08/05/2015
Last updated
08/05/2015
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