Provider Demographics
NPI:1972552917
Name:MANGOLD, DIANE SUE (LISW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:SUE
Last Name:MANGOLD
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 1:201 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4436
Mailing Address - Country:US
Mailing Address - Phone:712-262-2922
Mailing Address - Fax:712-262-3826
Practice Address - Street 1:824 FLINDT DR
Practice Address - Street 2:SUITE 103
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-3208
Practice Address - Country:US
Practice Address - Phone:712-732-3736
Practice Address - Fax:712-732-3275
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA061991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical