Provider Demographics
NPI:1336116599
Name:HIBMA, MARTHA F (LISW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:F
Last Name:HIBMA
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 1:3381 450TH ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-7507
Mailing Address - Country:US
Mailing Address - Phone:712-737-4713
Mailing Address - Fax:
Practice Address - Street 1:123 ALBANY AVE SE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1715
Practice Address - Country:US
Practice Address - Phone:712-737-4831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA047091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
16986Medicare ID - Type Unspecified