Basic Information
| Provider Information | |||||||||
| NPI: | 1922405653 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EWALD | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMHC CADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2750 SAINT FRANCIS DR | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507025644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192728922 | ||||||||
| FaxNumber: | 3192728929 | ||||||||
| Practice Location | |||||||||
| Address1: | 2750 SAINT FRANCIS DR | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507025644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192728922 | ||||||||
| FaxNumber: | 3192728929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2014 | ||||||||
| LastUpdateDate: | 03/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 11013 | IA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.