Healthcare Provider Details

I. General information

NPI: 1346311818
Provider Name (Legal Business Name): DENNIS LAGRANGE LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 DEPOT LN SE STE 100
CEDAR RAPIDS IA
52401-2547
US

IV. Provider business mailing address

1120 DEPOT LN SE STE 100
CEDAR RAPIDS IA
52401-2547
US

V. Phone/Fax

Practice location:
  • Phone: 319-310-2979
  • Fax:
Mailing address:
  • Phone: 319-310-2979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06350
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

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: