Provider Demographics
NPI:1174516785
Name:LARKIN, AMANDA LE (LISW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LE
Last Name:LARKIN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:MCCREA-CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2910
Mailing Address - Country:US
Mailing Address - Phone:641-682-8772
Mailing Address - Fax:
Practice Address - Street 1:110 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2910
Practice Address - Country:US
Practice Address - Phone:641-682-8772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05847104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA220784OtherIOWA HEALTH SOLUTIONS
IAP00043190OtherRAILROAD MEDICARE
IAI022OtherTRIWEST
IA0298372Medicaid
IAP00043190OtherRAILROAD MEDICARE
IA220784OtherIOWA HEALTH SOLUTIONS