Individual
CHARLOTTE MARIE NISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
201 E 11TH ST, SPENCER, IA 51301-4436
(712) 262-2922
(712) 262-3826
Mailing address
201 E 11TH ST, SPENCER, IA 51301-4436
(712) 262-2922
(712) 262-3826
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
00630
IA
Other
Enumeration date
05/10/2006
Last updated
11/08/2007
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