Provider Demographics
NPI:1255383014
Name:BRANDT, KATHY MARIE (MSW)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:MARIE
Last Name:BRANDT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:MARIE
Other - Last Name:RATHJE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1200 FIRST AVE EAST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:61301-4330
Mailing Address - Country:US
Mailing Address - Phone:712-264-6362
Mailing Address - Fax:712-262-1526
Practice Address - Street 1:1200 FIRST AVE EAST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4330
Practice Address - Country:US
Practice Address - Phone:712-264-6362
Practice Address - Fax:712-262-1526
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA030941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07653OtherWELLMARK BCBS
IA07653OtherWELLMARK BCBS