Provider Demographics
NPI:1194401976
Name:TRUNK, EMILY LAUREN
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:LAUREN
Last Name:TRUNK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 AURORA AVENUE SUITE 103E
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322
Mailing Address - Country:US
Mailing Address - Phone:515-401-6886
Mailing Address - Fax:
Practice Address - Street 1:6200 AURORA AVENUE SUITE 103E
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322
Practice Address - Country:US
Practice Address - Phone:515-401-6886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1173791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical