Provider Demographics
NPI:1851726160
Name:KETNER, MORGAN COBIE (LISW)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:COBIE
Last Name:KETNER
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 1:4620 E 53RD ST STE 235
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3620
Mailing Address - Country:US
Mailing Address - Phone:309-749-5173
Mailing Address - Fax:563-243-9567
Practice Address - Street 1:4620 E 53RD ST STE 235
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3620
Practice Address - Country:US
Practice Address - Phone:309-749-5173
Practice Address - Fax:563-243-9567
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA008191104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker