Kathryn M Bunge, LISW
Individual provider Active NPI Clinical Social Worker · Clear Lake, IA
NPI 1528039963 · NPPES record last updated Oct 8, 2012
Key facts
- NPI
- 1528039963
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 00173 (IA)
- Practice address
- 518 S 8TH St
Suite #207
Clear Lake, IA 50428-2577 - Phone
- (641) 357-0272
- Fax
- (641) 357-3059
- NPI assigned
- Feb 1, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00173 | IA | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 00173 | IA | Yes |
Addresses
Primary practice location
518 S 8TH St
Suite #207
Clear Lake, IA 50428-2577
Mailing address
518 S 8TH St
Suite #207
Clear Lake, IA 50428-2577
Phone (641) 357-0272
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21957 | Other | IA | MIDLANDS |
| 04645 | Other | IA | WELLMARK BLUE SHIELD |
| 04645 | Other | IA | WELLMARK ALLIANCE SELECT |
Other providers in Clear Lake, IA
- Margaret Bowen
- John Brady
- McKenzie Brekken
- Lindsey Noelle Brickey
- Brent E Brunsting
- Kaden Cameron
- Patrick Gerald Carney
- Anntaluhla Celestine
- Carlee Christianson
- Marla Christopher
All providers in Clear Lake, IA · Clinical Social Worker in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.