Healthcare Provider Details

I. General information

NPI: 1154252831
Provider Name (Legal Business Name): LIBBY LERAAS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 JACK TRICE WAY
AMES IA
50011-1801
US

IV. Provider business mailing address

1800 JACK TRICE WAY
AMES IA
50011-1801
US

V. Phone/Fax

Practice location:
  • Phone: 515-294-3662
  • Fax:
Mailing address:
  • Phone: 515-294-1816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: