Provider Demographics
NPI:1255847711
Name:POSPISIL, BEVERLY CATHERINE
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:CATHERINE
Last Name:POSPISIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 19TH AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2043
Mailing Address - Country:US
Mailing Address - Phone:319-329-1707
Mailing Address - Fax:
Practice Address - Street 1:1744 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2306
Practice Address - Country:US
Practice Address - Phone:319-366-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079155106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist