Provider Demographics
NPI:1255057535
Name:LUDWIG, ROBERT JAMES JR (MSED)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:LUDWIG
Suffix:JR
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 HOBART ST
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1251
Mailing Address - Country:US
Mailing Address - Phone:641-990-9921
Mailing Address - Fax:
Practice Address - Street 1:812 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-2143
Practice Address - Country:US
Practice Address - Phone:641-236-0273
Practice Address - Fax:641-236-7969
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA114858101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA114858OtherIA LICENSE