Provider Demographics
NPI:1003284092
Name:MEDINA PALMER, JUANA (LISW)
Entity Type:Individual
Prefix:
First Name:JUANA
Middle Name:
Last Name:MEDINA PALMER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:JUANA
Other - Middle Name:
Other - Last Name:MEDINA NAVARRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 COURT ST
Mailing Address - Street 2:PO BOX 1917
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1919
Mailing Address - Country:US
Mailing Address - Phone:712-252-3871
Mailing Address - Fax:712-222-1438
Practice Address - Street 1:625 COURT ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1919
Practice Address - Country:US
Practice Address - Phone:712-252-3871
Practice Address - Fax:712-222-1438
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0772221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical