Provider Demographics
NPI:1932230315
Name:MCLUEN-FELFHACKER, SALLY ANNE (LISW)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:ANNE
Last Name:MCLUEN-FELFHACKER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E SUMMIT ST
Mailing Address - Street 2:P.O. BOX 273
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-2746
Mailing Address - Country:US
Mailing Address - Phone:641-782-9625
Mailing Address - Fax:641-782-9625
Practice Address - Street 1:1001 E SUMMIT ST
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-2746
Practice Address - Country:US
Practice Address - Phone:641-782-9625
Practice Address - Fax:641-782-9625
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA725OtherL.I.S.W. LICENSE NUMBER
IA14496Medicare ID - Type UnspecifiedL.I.S.W. PROVIDER NUMBER