Basic Information
| Provider Information | |||||||||
| NPI: | 1154852531 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMALL | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 65 | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 510010065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7124220388 | ||||||||
| FaxNumber: | 7122523157 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 COURT ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511011919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122523871 | ||||||||
| FaxNumber: | 7122523157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2017 | ||||||||
| LastUpdateDate: | 12/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 083358 | IA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 083358 | 01 | IA | IOWA BOARD OF PROFESSIONAL LICENSURE | OTHER |