Provider Demographics
NPI:1316587132
Name:ADOLPHSON, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:ADOLPHSON
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 1:218 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WAPELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52653-1202
Mailing Address - Country:US
Mailing Address - Phone:319-527-4455
Mailing Address - Fax:
Practice Address - Street 1:218 N 2ND ST
Practice Address - Street 2:
Practice Address - City:WAPELLO
Practice Address - State:IA
Practice Address - Zip Code:52653-1202
Practice Address - Country:US
Practice Address - Phone:319-527-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health