Provider Demographics
NPI:1396021580
Name:EBNER, CYNTHIA ANN (LISW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:EBNER
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 1:209 1ST STREET NE #105
Mailing Address - Street 2:PO BOX 258
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041
Mailing Address - Country:US
Mailing Address - Phone:712-707-9222
Mailing Address - Fax:712-707-9220
Practice Address - Street 1:505 5TH ST STE 510
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1506
Practice Address - Country:US
Practice Address - Phone:712-258-4553
Practice Address - Fax:712-258-4773
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0069651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical