MEDICARE: DENNIS LAGRANGE LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	06350	IA
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1346311818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS LAGRANGE LISW

Provider Business Mailing Address
First Line	:	1120 DEPOT LN SE STE 100
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52401-2547
Country	:	US
Telephone Number	:	319-310-2979
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 DEPOT LN SE STE 100
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52401-2547
Country	:	US
Telephone Number	:	319-310-2979
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	09/02/2025

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Directions to “ DENNIS LAGRANGE LISW” Practice Location

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