Provider Demographics
NPI:1811162415
Name:SCHNACK, MARY A (LISW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:SCHNACK
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N MISSISSIPPI ST
Mailing Address - Street 2:
Mailing Address - City:BLUE GRASS
Mailing Address - State:IA
Mailing Address - Zip Code:52726-9733
Mailing Address - Country:US
Mailing Address - Phone:563-579-7790
Mailing Address - Fax:
Practice Address - Street 1:1730 WILKES AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-3546
Practice Address - Country:US
Practice Address - Phone:563-579-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02833104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker