Provider Demographics
NPI:1972588267
Name:BEXTINE, HEDY (LISW LMFT MSW)
Entity Type:Individual
Prefix:MS
First Name:HEDY
Middle Name:
Last Name:BEXTINE
Suffix:
Gender:F
Credentials:LISW LMFT MSW
Other - Prefix:MS
Other - First Name:HEDY
Other - Middle Name:A
Other - Last Name:BEXTINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW LMFT MSW
Mailing Address - Street 1:118 2ND ST SE
Mailing Address - Street 2:STE 220
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-1210
Mailing Address - Country:US
Mailing Address - Phone:319-362-0632
Mailing Address - Fax:319-362-5206
Practice Address - Street 1:118 2ND ST SE
Practice Address - Street 2:STE 220
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-1210
Practice Address - Country:US
Practice Address - Phone:319-362-0632
Practice Address - Fax:319-362-5206
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2104104100000X
IA00133106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
20032571487726OtherPRINCIPAL
36074OtherBCBS
IA6226210OtherUBH
2070318OtherCIGNA
2157352OtherFIRST HEALTH
224832OtherMANAGED HEALTH NETWORK
IA36074OtherWELLMARK
7579033OtherHAI EAP
7579033OtherAETNA
IA6226210OtherUBH
224832OtherMANAGED HEALTH NETWORK