Basic Information
| Provider Information | |||||||||
| NPI: | 1750830097 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEREN | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9601 COUNTY ROAD 410 | ||||||||
| Address2: | |||||||||
| City: | HANNIBAL | ||||||||
| State: | MO | ||||||||
| PostalCode: | 634016582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732211334 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6420 COUNCIL ST NE | ||||||||
| Address2: | |||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524021129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883656271 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2016 | ||||||||
| LastUpdateDate: | 09/18/2019 | ||||||||
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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 | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 2019024949 | MO | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 098328 | IA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.