Provider Demographics
NPI:1023281029
Name:DITTMER, JONI LYNN (LISW)
Entity type:Individual
Prefix:MS
First Name:JONI
Middle Name:LYNN
Last Name:DITTMER
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 1:12090 240TH ST
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-9400
Mailing Address - Country:US
Mailing Address - Phone:563-320-4395
Mailing Address - Fax:563-285-4014
Practice Address - Street 1:718 BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-5620
Practice Address - Country:US
Practice Address - Phone:563-320-4395
Practice Address - Fax:563-285-4014
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA008821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical