Provider Demographics
NPI:1346338134
Name:ESCH, MICHAEL J (LISW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:ESCH
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 PIERCE ST
Mailing Address - Street 2:STE 100
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3871
Mailing Address - Country:US
Mailing Address - Phone:712-255-8323
Mailing Address - Fax:712-255-8287
Practice Address - Street 1:2212 PIERCE ST
Practice Address - Street 2:STE 100
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3871
Practice Address - Country:US
Practice Address - Phone:712-255-8323
Practice Address - Fax:712-255-8287
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA003241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1152322Medicaid
IA06783Medicare ID - Type Unspecified