Healthcare Provider Details

I. General information

NPI: 1639771025
Provider Name (Legal Business Name): LYANN WESTERN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 11/11/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W 18TH ST
CEDAR FALLS IA
50613-3432
US

IV. Provider business mailing address

1400 W 18TH ST
CEDAR FALLS IA
50613-3432
US

V. Phone/Fax

Practice location:
  • Phone: 319-429-2037
  • Fax:
Mailing address:
  • Phone: 319-429-2037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number05960
License Number StateIA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: