Basic Information
| Provider Information | |||||||||
| NPI: | 1124354352 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATCHORN | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | MADSEN | ||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | INTEGRATED COUNSELING | ||||||||
| Address2: | 921 PIERCE | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122550232 | ||||||||
| FaxNumber: | 7122550354 | ||||||||
| Practice Location | |||||||||
| Address1: | NSELING PRACTICE | ||||||||
| Address2: | 915 PIERCE ST | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122550232 | ||||||||
| FaxNumber: | 7122550354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2009 | ||||||||
| LastUpdateDate: | 10/22/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 01687 | IA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.