Healthcare Provider Details

I. General information

NPI: 1477261782
Provider Name (Legal Business Name): JESSICA L NAUHOLZ LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 08/19/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 ORCHARD DR
CEDAR FALLS IA
50613-5898
US

IV. Provider business mailing address

3421 W 9TH ST MEDICAL AFFAIRS - PROVIDER ENROLLMENT
WATERLOO IA
50702-5401
US

V. Phone/Fax

Practice location:
  • Phone: 319-268-9700
  • Fax: 319-268-1934
Mailing address:
  • Phone: 319-272-7304
  • Fax: 319-272-7318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number008272
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: