Provider Demographics
NPI:1124708383
Name:HUNGERFORD, FANNIE K (TLMFT)
Entity type:Individual
Prefix:
First Name:FANNIE
Middle Name:K
Last Name:HUNGERFORD
Suffix:
Gender:F
Credentials:TLMFT
Other - Prefix:
Other - First Name:FRANCES
Other - Middle Name:K
Other - Last Name:HUNGERFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:18 GLENDALE CT
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-4430
Mailing Address - Country:US
Mailing Address - Phone:773-575-4236
Mailing Address - Fax:
Practice Address - Street 1:103 E COLLEGE ST STE 208
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4008
Practice Address - Country:US
Practice Address - Phone:773-575-4236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA120112106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist