Individual
ELIZABETH A CLANCY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
210 4TH AVE, GRINNELL, IA 50112-1898
(641) 236-7511
Mailing address
210 4TH AVE, GRINNELL, IA 50112-1898
(641) 236-7511
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
085027
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085027
STATE LICENSE
IA
Enumeration date
07/03/2018
Last updated
07/03/2018
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