Individual
MARY FUNKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
709 W MAIN ST, MANCHESTER, IA 52057-1526
(563) 927-7330
(563) 927-7409
Mailing address
709 W MAIN ST, MANCHESTER, IA 52057-1526
(563) 927-7330
(563) 927-7409
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
02500
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0091637
—
IA
01
—
09971
BCIA
IA
01
—
248730
MIDLANDS
IA
01
—
IA0151
JOHN DEERE
IA
Enumeration date
04/10/2006
Last updated
07/08/2007
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