Provider Demographics
NPI:1043683048
Name:TOWNSEND, MARY KAY
Entity type:Individual
Prefix:
First Name:MARY KAY
Middle Name:
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 S 2ND ST
Mailing Address - Street 2:PO BOX 130
Mailing Address - City:WEST BRANCH
Mailing Address - State:IA
Mailing Address - Zip Code:52358-9620
Mailing Address - Country:US
Mailing Address - Phone:319-643-2532
Mailing Address - Fax:319-643-5708
Practice Address - Street 1:233 S 2ND ST
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:IA
Practice Address - Zip Code:52358-9620
Practice Address - Country:US
Practice Address - Phone:319-643-2532
Practice Address - Fax:319-643-5708
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical