Provider Demographics
NPI:1740545912
Name:HUNTER, TAMARA MARIE WIRTH (LISW)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:MARIE WIRTH
Last Name:HUNTER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:M
Other - Last Name:WIRTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:103 E 6TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6300
Mailing Address - Country:US
Mailing Address - Phone:515-337-2872
Mailing Address - Fax:515-288-9109
Practice Address - Street 1:103 E 6TH ST STE 101
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6300
Practice Address - Country:US
Practice Address - Phone:515-337-2872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0079461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical