Healthcare Provider Details

I. General information

NPI: 1912398835
Provider Name (Legal Business Name): LISA FERRETTI LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1957 BLAIRS FERRY RD NE SUITE 600
CEDAR RAPIDS IA
52402-5891
US

IV. Provider business mailing address

1957 BLAIRS FERRY RD NE SUITE 600
CEDAR RAPIDS IA
52402-5891
US

V. Phone/Fax

Practice location:
  • Phone: 319-440-0751
  • Fax: 319-409-8071
Mailing address:
  • Phone: 319-440-0751
  • Fax: 319-409-8071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number072190
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: