Provider Demographics
NPI:1679672554
Name:BARTOLLAS, LINDA D (LISW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:D
Last Name:BARTOLLAS
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 1:146 WEST DALE STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703
Mailing Address - Country:US
Mailing Address - Phone:319-233-3351
Mailing Address - Fax:319-235-3132
Practice Address - Street 1:146 WEST DALE STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703
Practice Address - Country:US
Practice Address - Phone:319-233-3351
Practice Address - Fax:319-235-3132
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05971104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1144634Medicaid
IA1144634Medicaid