Provider Demographics
NPI:1043554678
Name:TIMMERMAN, CATHI SUE (LISW)
Entity Type:Individual
Prefix:
First Name:CATHI
Middle Name:SUE
Last Name:TIMMERMAN
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 1:942 WILLOW LN
Mailing Address - Street 2:PO BOX 748
Mailing Address - City:LISBON
Mailing Address - State:IA
Mailing Address - Zip Code:52253-9807
Mailing Address - Country:US
Mailing Address - Phone:319-551-9203
Mailing Address - Fax:
Practice Address - Street 1:5270 N PARK PL NE
Practice Address - Street 2:SUITE 113
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-6222
Practice Address - Country:US
Practice Address - Phone:319-551-9203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA059851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical