Provider Demographics
NPI:1003002114
Name:PATSCHKE, BARBARA JEAN (ISW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:PATSCHKE
Suffix:
Gender:F
Credentials:ISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-0337
Mailing Address - Country:US
Mailing Address - Phone:319-369-7091
Mailing Address - Fax:319-369-7071
Practice Address - Street 1:855 A AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5057
Practice Address - Country:US
Practice Address - Phone:319-369-7091
Practice Address - Fax:319-369-7071
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA009331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI21443Medicare PIN