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 |