Provider Demographics
NPI:1679789614
Name:MOELLER-SUNDERMAN, ROBIN L (MSW, LISW)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:L
Last Name:MOELLER-SUNDERMAN
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575-160TH ST.
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-5023
Mailing Address - Country:US
Mailing Address - Phone:712-542-4266
Mailing Address - Fax:712-542-4725
Practice Address - Street 1:SOUTHWEST IOWA FAMILIES
Practice Address - Street 2:215 E. WASHINGTON ST.
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632
Practice Address - Country:US
Practice Address - Phone:712-542-3501
Practice Address - Fax:712-542-4725
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA010501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA028975000Medicaid