Provider Demographics
NPI:1215220223
Name:WIEBEN, VICTORIA MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARIE
Last Name:WIEBEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:VAN HORNE
Mailing Address - State:IA
Mailing Address - Zip Code:52346-0004
Mailing Address - Country:US
Mailing Address - Phone:319-361-6529
Mailing Address - Fax:319-228-8776
Practice Address - Street 1:3113 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-4524
Practice Address - Country:US
Practice Address - Phone:319-361-6529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0076261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical