Individual
SHANTEL MARIE BASURTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
3316 CEDAR HEIGHTS DR, SUITE A, CEDAR FALLS, IA 50613-6083
(319) 504-4593
(319) 274-9147
Mailing address
3316 CEDAR HEIGHTS DR STE A, CEDAR FALLS, IA 50613-6083
(319) 504-4593
(319) 260-1212
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
008183
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0707633
—
IA
Enumeration date
10/14/2015
Last updated
10/02/2018
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