Provider Demographics
NPI:1043682875
Name:MENSTER, MARIA TERESE (MSE, IADC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESE
Last Name:MENSTER
Suffix:
Gender:F
Credentials:MSE, IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 E KIMBERLY RD
Mailing Address - Street 2:STE. 200 NORTH
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-7205
Mailing Address - Country:US
Mailing Address - Phone:563-355-0055
Mailing Address - Fax:563-355-0101
Practice Address - Street 1:2322 E KIMBERLY RD
Practice Address - Street 2:STE. 200 NORTH
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-7205
Practice Address - Country:US
Practice Address - Phone:563-355-0055
Practice Address - Fax:563-355-0101
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA12115101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)