Provider Demographics
NPI:1245329432
Name:NELSON, PATRICIA G (LISW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:G
Last Name:NELSON
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 1:800 FIRST ST NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405
Mailing Address - Country:US
Mailing Address - Phone:319-396-1066
Mailing Address - Fax:319-396-8779
Practice Address - Street 1:208 COLLINS ROAD NE
Practice Address - Street 2:SUITE 201
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-364-4822
Practice Address - Fax:319-337-6563
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0421594Medicaid
IA56021OtherBCBS
IA099796000Medicaid
IA10474002Medicare PIN
IA42316Medicare UPIN
IA099796000Medicaid