Provider Demographics
NPI:1003219445
Name:MCCALL, AMANDA JO (LISW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:MCCALL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21276 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CASTANA
Mailing Address - State:IA
Mailing Address - Zip Code:51010-8735
Mailing Address - Country:US
Mailing Address - Phone:712-371-9423
Mailing Address - Fax:
Practice Address - Street 1:1013 10TH ST
Practice Address - Street 2:
Practice Address - City:ONAWA
Practice Address - State:IA
Practice Address - Zip Code:51040-1614
Practice Address - Country:US
Practice Address - Phone:712-433-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0734191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical