Provider Demographics
NPI:1700172475
Name:PHELPS, NANCY LYNN (LISW, LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:PHELPS
Suffix:
Gender:F
Credentials:LISW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18021 290TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:52756-9509
Mailing Address - Country:US
Mailing Address - Phone:563-593-0790
Mailing Address - Fax:563-285-8076
Practice Address - Street 1:3575 JERSEY RIDGE RD STE 3
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2292
Practice Address - Country:US
Practice Address - Phone:563-593-0790
Practice Address - Fax:563-285-8076
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1041C0700X
IA060681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical