Provider Demographics
NPI:1093703878
Name:OSWALD, KRISTINE F (LISW)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:F
Last Name:OSWALD
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 1:270 W DAVENPORT ST
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-1250
Mailing Address - Country:US
Mailing Address - Phone:563-639-9885
Mailing Address - Fax:
Practice Address - Street 1:270 W DAVENPORT ST
Practice Address - Street 2:
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748-1250
Practice Address - Country:US
Practice Address - Phone:563-639-9885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA012571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01A3OtherJOHN DEERE HEALTH PLAN
IA0446104Medicaid
IA42659OtherWELLMARK HEALTH PLAN
IA01A3OtherJOHN DEERE HEALTH PLAN
IA0446104Medicaid