Provider Demographics
NPI:1306640800
Name:FOLSOM, ELIZABETH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:FOLSOM
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 1:206 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50579-1124
Mailing Address - Country:US
Mailing Address - Phone:712-297-4064
Mailing Address - Fax:
Practice Address - Street 1:2520 9TH AVE S
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5440
Practice Address - Country:US
Practice Address - Phone:515-293-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician