Organization
KIMBERLY ANNE CONRAD PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY ANNE CONRAD SED (DIRECTOR)
(319) 240-0944
Entity
Organization
Contact information
Practice address
100 1ST AVE SW, WAUCOMA, IA 52171-9705
(563) 776-4060
(563) 776-4061
Mailing address
25271 JOHNSONS MILL RD, WAUCOMA, IA 52171-7137
(219) 240-0944
(563) 776-4061
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
Primary
351029
IA
251S00000X
Community/Behavioral Health Agency
06449
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0470138
—
IA
05
—
1012617
—
IA
Enumeration date
11/01/2006
Last updated
10/25/2007
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