Provider Demographics
NPI:1962403220
Name:SIGUENZA, EDGAR J (LISW)
Entity type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:J
Last Name:SIGUENZA
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-2713
Mailing Address - Country:US
Mailing Address - Phone:319-396-1066
Mailing Address - Fax:319-396-8779
Practice Address - Street 1:3100 E AVE NW
Practice Address - Street 2:STE 101
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-2962
Practice Address - Country:US
Practice Address - Phone:319-396-3110
Practice Address - Fax:319-396-8779
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA36843OtherBCBS
E29299Medicare UPIN