Organization
MARISA MANSFIELD, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARISA MANSFIELD LISW (CLINICAL SOCIAL WORKER)
(563) 362-2815
Entity
Organization
Contact information
Practice address
1926 W 4TH ST, DAVENPORT, IA 52802-1628
(563) 362-2815
Mailing address
1037 MEADOWVIEW LN, DAVENPORT, IA 52806-2807
(563) 676-8521
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
082627
CLINICAL LICENSE
IA
Enumeration date
04/14/2021
Last updated
04/14/2021
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