Most Relevant Information
Provider Data
| NPI Number: | 1003288853 |
| Provider Name: | TIA PAINTER CADC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 14104 |
Most Important Dates
| Enumeration Date: | 10/20/2015 |
| Last Updated: | 10/20/2015 |
Provider Practice Location
1506 31ST AVE N
FORT DODGE
IA
505017274
Practice Location Phone/Fax
| Phone: | 5155767261 |
| Fax: | 5159557652 |
Provider Mailing Location
1506 31ST AVE N
FORT DODGE
IA
505017274
Provider Mailing Phone/Fax
| Phone: | 5155767261 |
| Fax: | 5159557652 |