Provider Demographics
NPI:1073522306
Name:PHELPS, HARRIET A (PSYD, LISW)
Entity Type:Individual
Prefix:DR
First Name:HARRIET
Middle Name:A
Last Name:PHELPS
Suffix:
Gender:F
Credentials:PSYD, LISW
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 2783
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52809-2783
Mailing Address - Country:US
Mailing Address - Phone:563-381-8088
Mailing Address - Fax:563-381-8077
Practice Address - Street 1:718 BRIDGE AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-5620
Practice Address - Country:US
Practice Address - Phone:563-381-8088
Practice Address - Fax:563-381-8077
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA008511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA216358OtherIOWA HEALTH
IA486768000OtherMAGELLAN
IA0457481Medicaid
1073522306OtherTRICARE/CHAMPUS
IA396294OtherVALUE OPTIONS RAILROAD
IA36005OtherWELLMARK
IA238252OtherMIDLANDS CHOICE
IA246562OtherCOMPSYCH
IA800013870OtherRAILROAD MEDICARE
IA800013870OtherRAILROAD MEDICARE