Provider Demographics
NPI:1336207976
Name:VONTERSCH HANNO, MARY J (MSW LISW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:J
Last Name:VONTERSCH HANNO
Suffix:
Gender:F
Credentials:MSW LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 FLOYD BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51108
Mailing Address - Country:US
Mailing Address - Phone:712-239-0392
Mailing Address - Fax:712-239-0824
Practice Address - Street 1:3133 FLOYD BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51108
Practice Address - Country:US
Practice Address - Phone:712-239-0392
Practice Address - Fax:712-239-0824
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE073590Medicaid
IA0242461Medicaid
41938OtherBCBS
IA0242461Medicaid