Provider Demographics
NPI:1710101936
Name:HIBMA, MARLENE MARIE (LISW)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:MARIE
Last Name:HIBMA
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:JOHNSON
Other - Last Name:HIBMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW
Mailing Address - Street 1:2611 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219
Mailing Address - Country:US
Mailing Address - Phone:641-628-9599
Mailing Address - Fax:641-621-1493
Practice Address - Street 1:2611 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219
Practice Address - Country:US
Practice Address - Phone:641-628-9599
Practice Address - Fax:641-621-1493
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00802104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker