Healthcare Provider Details

I. General information

NPI: 1689132524
Provider Name (Legal Business Name): CHELSEA ANN SMORSTAD LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 11TH ST NW
CEDAR RAPIDS IA
52405-3811
US

IV. Provider business mailing address

520 11TH ST NW
CEDAR RAPIDS IA
52405-3811
US

V. Phone/Fax

Practice location:
  • Phone: 319-398-3562
  • Fax: 319-398-3501
Mailing address:
  • Phone: 319-398-3562
  • Fax: 319-398-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19030
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number008339
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: