Provider Demographics
NPI:1629429964
Name:ELM, ERIN E
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:ELM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 UTICA RIDGE RD
Mailing Address - Street 2:STE F
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1653
Mailing Address - Country:US
Mailing Address - Phone:563-359-6750
Mailing Address - Fax:
Practice Address - Street 1:3515 SPRING ST
Practice Address - Street 2:SUITE 3
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2100
Practice Address - Country:US
Practice Address - Phone:563-359-6750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081673104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker