Basic Information
| Provider Information | |||||||||
| NPI: | 1346746765 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BULVER | ||||||||
| FirstName: | LAVERN | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1316 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CLARION | ||||||||
| State: | IA | ||||||||
| PostalCode: | 505252019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5155322811 | ||||||||
| FaxNumber: | 3193431161 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 13TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | CLARION | ||||||||
| State: | IA | ||||||||
| PostalCode: | 505252078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5155322836 | ||||||||
| FaxNumber: | 5155322523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2018 | ||||||||
| LastUpdateDate: | 04/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 06448 | IA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.