Provider Demographics
NPI:1629189683
Name:STEM-PETERSON, MARTHA A (LISW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:A
Last Name:STEM-PETERSON
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 1:24897 310TH ST
Mailing Address - Street 2:
Mailing Address - City:NEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:51559-4125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 RIDGE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4643
Practice Address - Country:US
Practice Address - Phone:712-396-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00853104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker