Provider Demographics
NPI:1265013361
Name:ONDLER, AMY MARIE (LISW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:ONDLER
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 1:1820 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-2409
Mailing Address - Country:US
Mailing Address - Phone:800-592-0180
Mailing Address - Fax:712-566-5229
Practice Address - Street 1:1004 4TH AVE SW
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-5617
Practice Address - Country:US
Practice Address - Phone:800-592-0180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA092662104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker