Provider Demographics
NPI:1265804082
Name:WEDERQUIST ZANDERS, KATRINA (TINA) K (MS, LMSW)
Entity type:Individual
Prefix:MRS
First Name:KATRINA (TINA)
Middle Name:K
Last Name:WEDERQUIST ZANDERS
Suffix:
Gender:F
Credentials:MS, LMSW
Other - Prefix:MRS
Other - First Name:TINA
Other - Middle Name:K
Other - Last Name:ZANDERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LMSW
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:409 1/2 W 7TH CATHOLIC CHARITIES
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401
Mailing Address - Country:US
Mailing Address - Phone:712-792-9597
Mailing Address - Fax:712-792-6146
Practice Address - Street 1:409 1/2 W 7TH
Practice Address - Street 2:CATHOLIC CHARITIES
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401
Practice Address - Country:US
Practice Address - Phone:712-792-9597
Practice Address - Fax:712-792-6146
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IALMSW02963104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker