Provider Demographics
NPI:1578640850
Name:SCHUT, MARTHA J (LISW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
Last Name:SCHUT
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 1:123 N LINN ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-2143
Mailing Address - Country:US
Mailing Address - Phone:319-337-3357
Mailing Address - Fax:319-337-2758
Practice Address - Street 1:123 N LINN ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2143
Practice Address - Country:US
Practice Address - Phone:319-337-3357
Practice Address - Fax:319-337-2758
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA013581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA24473OtherWELLMARK BCBS