Provider Demographics
NPI:1558899179
Name:JULIANNA GONDEK LISW LLC
Entity Type:Organization
Organization Name:JULIANNA GONDEK LISW LLC
Other - Org Name:EASTERN IOWA FAMILY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/LISW
Authorized Official - Prefix:
Authorized Official - First Name:JULIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONDEK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:319-777-1092
Mailing Address - Street 1:204 GLENN ST SE STE 2
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IA
Mailing Address - Zip Code:52314-1501
Mailing Address - Country:US
Mailing Address - Phone:319-777-1092
Mailing Address - Fax:319-449-3585
Practice Address - Street 1:204 GLENN ST SE STE 2
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314-1501
Practice Address - Country:US
Practice Address - Phone:319-777-1092
Practice Address - Fax:319-449-3585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0073201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0113927Medicaid