Provider Demographics
NPI:1083927834
Name:MOSSMAN, LYDIA (LISW)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:MOSSMAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:KUBIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2027
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52244-2027
Mailing Address - Country:US
Mailing Address - Phone:319-339-3855
Mailing Address - Fax:319-358-2791
Practice Address - Street 1:2055 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-4704
Practice Address - Country:US
Practice Address - Phone:319-338-1324
Practice Address - Fax:319-338-2866
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health