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NPI Code Detail

MEDICARE: MR. TROY ALLEN RAYMER LISW

MEDICARE: MR. TROY ALLEN RAYMER 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
11041C0700XClinical Social Worker080102IA
21041C0700XClinical Social Worker149.028346IL

General Provider Information

NPI Number : 1447857867
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TROY ALLEN RAYMER LISW
Provider Business Mailing Address
First Line : 2213 2ND ST
Second Line :
City : CORALVILLE
State : IA
Zip : 52241-1205
Country : US
Telephone Number : 319-480-4956
Fax Number :
Provider Business Practice Location Address
First Line : 2213 2ND ST
Second Line :
City : CORALVILLE
State : IA
Zip : 52241-1205
Country : US
Telephone Number : 319-480-4956
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2020
Last Update Date : 12/19/2025

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