Provider Demographics
NPI:1114787140
Name:MARTZAHL, LORETTA L (LMSW)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:L
Last Name:MARTZAHL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HUXLEY
Mailing Address - State:IA
Mailing Address - Zip Code:50124-8117
Mailing Address - Country:US
Mailing Address - Phone:515-209-1336
Mailing Address - Fax:
Practice Address - Street 1:1850 SW PLAZA SHOPS LN
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-7167
Practice Address - Country:US
Practice Address - Phone:515-508-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA116959104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker