Provider Demographics
NPI:1447273875
Name:STETZEL, ROMA MARIE (MSW)
Entity type:Individual
Prefix:MS
First Name:ROMA
Middle Name:MARIE
Last Name:STETZEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50115-1248
Mailing Address - Country:US
Mailing Address - Phone:641-332-2835
Mailing Address - Fax:641-332-2834
Practice Address - Street 1:1004 OAK ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50115-1248
Practice Address - Country:US
Practice Address - Phone:641-332-2835
Practice Address - Fax:641-332-2834
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05511104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0254938Medicaid
IABLUE CROSS/BLUE SHEIOtherWELLMARK
IA0254938Medicaid