Provider Demographics
NPI:1144911793
Name:RECKER, TINA (LMSW)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:RECKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1789 250TH AVE
Mailing Address - Street 2:
Mailing Address - City:EARLVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52041-8646
Mailing Address - Country:US
Mailing Address - Phone:319-210-0314
Mailing Address - Fax:
Practice Address - Street 1:721 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-2048
Practice Address - Country:US
Practice Address - Phone:563-927-6700
Practice Address - Fax:563-627-6703
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA117584104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA117584OtherSTATE LICENSE