Provider Demographics
NPI:1700231214
Name:TALLMAN, DANIEL (LMSW, CADC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:TALLMAN
Suffix:
Gender:M
Credentials:LMSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-4852
Mailing Address - Country:US
Mailing Address - Phone:319-621-2587
Mailing Address - Fax:
Practice Address - Street 1:595 ASHLEY CT STE 7
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-4758
Practice Address - Country:US
Practice Address - Phone:319-621-2587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2019-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17049101YA0400X
IA0953661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)