Provider Demographics
NPI:1376540591
Name:KNIERIM, LINDA S (LISW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:KNIERIM
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 1:719 5TH AVE
Mailing Address - Street 2:STE. 3
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1604
Mailing Address - Country:US
Mailing Address - Phone:641-236-3090
Mailing Address - Fax:
Practice Address - Street 1:719 5TH AVE
Practice Address - Street 2:STE. 3
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-1604
Practice Address - Country:US
Practice Address - Phone:641-236-3090
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00553101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA04131Medicare ID - Type Unspecified