Healthcare Provider Details

I. General information

NPI: 1578833257
Provider Name (Legal Business Name): KAROL L. WHITE LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 09/18/2021
Certification Date: 09/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 1ST AVE SE STE 503
CEDAR RAPIDS IA
52402-3257
US

IV. Provider business mailing address

4403 1ST AVE SE STE 503
CEDAR RAPIDS IA
52402-3257
US

V. Phone/Fax

Practice location:
  • Phone: 319-651-5955
  • Fax:
Mailing address:
  • Phone: 319-651-5955
  • Fax: 319-393-3458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007106
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: