Provider Demographics
NPI:1902446305
Name:MARKWITZ, MALLORY ROSE (LISW, LMSW)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:ROSE
Last Name:MARKWITZ
Suffix:
Gender:F
Credentials:LISW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PRAIRIE HILL DR
Mailing Address - Street 2:
Mailing Address - City:ATKINS
Mailing Address - State:IA
Mailing Address - Zip Code:52206-8301
Mailing Address - Country:US
Mailing Address - Phone:319-594-1000
Mailing Address - Fax:
Practice Address - Street 1:1340 BLAIRS FERRY RD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-1900
Practice Address - Country:US
Practice Address - Phone:319-398-6575
Practice Address - Fax:319-369-4673
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0816111041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker