MEDICARE: MS. JAMI LYNN MALONE 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	05885	IA

General Provider Information

NPI Number	:	1679639843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAMI LYNN MALONE LISW

Provider Business Mailing Address
First Line	:	3408 WOODLAND AVE STE 210A
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-6506
Country	:	US
Telephone Number	:	515-421-7891
Fax Number	:	515-608-4484

Provider Business Practice Location Address
First Line	:	3408 WOODLAND AVE
Second Line	:	SUITE 210 D
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-6506
Country	:	US
Telephone Number	:	515-421-7891
Fax Number	:	515-608-4484

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

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	01/25/2025

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