Provider Demographics
NPI:1407921828
Name:WHITAKER, NANCY JO (LISW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JO
Last Name:WHITAKER
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 1:1519 S GILBERT ST
Mailing Address - Street 2:FAMILY SYSTEMS THERAPY AND COUNSELING SERVICES
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-4367
Mailing Address - Country:US
Mailing Address - Phone:319-351-4415
Mailing Address - Fax:319-354-8956
Practice Address - Street 1:1519 S GILBERT ST
Practice Address - Street 2:FAMILY SYSTEMS THERAPY AND COUNSELING SERVICES
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4367
Practice Address - Country:US
Practice Address - Phone:319-351-4415
Practice Address - Fax:319-354-8956
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06115104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1407921828Medicaid