Provider Demographics
NPI:1265800064
Name:GUERDET, JOHANNA RACHAEL (LISW)
Entity type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:RACHAEL
Last Name:GUERDET
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 1:5408 NW 88TH ST STE 130
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2953
Mailing Address - Country:US
Mailing Address - Phone:319-795-2808
Mailing Address - Fax:
Practice Address - Street 1:5408 NW 88TH ST STE 130
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2953
Practice Address - Country:US
Practice Address - Phone:515-244-2267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0080641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical