Individual
THERESE KORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
147 15TH AVE, COUNCIL BLUFFS, IA 51503-6827
(712) 325-1331
Mailing address
3306 S 48TH AVENUE CIR, OMAHA, NE 68106-4062
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
001286
IA
Other
Enumeration date
03/05/2013
Last updated
03/05/2013
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