Provider Demographics
NPI:1477997468
Name:DRELICH, ELIZABETH W (LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:W
Last Name:DRELICH
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 SAINT FRANCIS DR STE 210
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5664
Mailing Address - Country:US
Mailing Address - Phone:319-272-5000
Mailing Address - Fax:
Practice Address - Street 1:2710 SAINT FRANCIS DR STE 210
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5664
Practice Address - Country:US
Practice Address - Phone:319-272-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6549101YS0200X
IA0721221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6549OtherLISW -CP
IA072122OtherLICENSE