Provider Demographics
NPI:1720180706
Name:DIFFERDING, PATRICIA LEE (MSW, LISW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LEE
Last Name:DIFFERDING
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:SWISHER
Mailing Address - State:IA
Mailing Address - Zip Code:52338-0177
Mailing Address - Country:US
Mailing Address - Phone:319-857-4958
Mailing Address - Fax:319-339-7048
Practice Address - Street 1:601 HIGHWAY 6 W
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-2292
Practice Address - Country:US
Practice Address - Phone:319-338-0581
Practice Address - Fax:319-339-7048
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA022001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical