Provider Demographics
NPI:1922263102
Name:MOATS, JENNIFER L (LBSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MOATS
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1427
Mailing Address - Country:US
Mailing Address - Phone:515-971-7605
Mailing Address - Fax:
Practice Address - Street 1:408 5TH ST NW
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1427
Practice Address - Country:US
Practice Address - Phone:515-971-7605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-27
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04652104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker