Provider Demographics
NPI:1831356872
Name:HILL SUTHERLAND, MARY LYNN (LISW CEAP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:LYNN
Last Name:HILL SUTHERLAND
Suffix:
Gender:F
Credentials:LISW CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 EAST 56TH STREET
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807
Mailing Address - Country:US
Mailing Address - Phone:563-386-4004
Mailing Address - Fax:563-386-4026
Practice Address - Street 1:4455 E 56TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2995
Practice Address - Country:US
Practice Address - Phone:563-386-4004
Practice Address - Fax:563-386-4026
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01325104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker