Provider Demographics
NPI:1770840837
Name:WEBER-MADISON, SONYA DEE (LCSW)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:DEE
Last Name:WEBER-MADISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 LINCOLN RD STE 210
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4149
Mailing Address - Country:US
Mailing Address - Phone:563-293-6989
Mailing Address - Fax:563-200-1240
Practice Address - Street 1:1035 LINCOLN RD STE 210
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-4149
Practice Address - Country:US
Practice Address - Phone:563-293-6989
Practice Address - Fax:563-200-1240
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007974104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker