Healthcare Provider Details

I. General information

NPI: 1972625119
Provider Name (Legal Business Name): CAROL GORDON WARMBIER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL ANN GORDON LISW

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E CALL ST
ALGONA IA
50511-2444
US

IV. Provider business mailing address

PO BOX 474
HUMBOLDT IA
50548-0474
US

V. Phone/Fax

Practice location:
  • Phone: 515-295-3334
  • Fax: 515-295-3337
Mailing address:
  • Phone: 515-295-3334
  • Fax: 515-295-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number02481
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier11764704
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerCAQH
# 2
Identifier138200
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerHEALTH ALLIANCE
# 3
Identifier252903
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerMIDLANDS CHOICE
# 4
Identifier55339
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBLUE CROSS
# 5
Identifier1972625199
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 6
Identifier2163631
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerCOMPSYCH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: