Healthcare Provider Details

I. General information

NPI: 1750574109
Provider Name (Legal Business Name): MELINDA O'LEARY LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 11/02/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 3RD ST SE SUITE 514
CEDAR RAPIDS IA
52401-1514
US

IV. Provider business mailing address

222 3RD ST SE SUITE 514
CEDAR RAPIDS IA
52401-1514
US

V. Phone/Fax

Practice location:
  • Phone: 319-360-5041
  • Fax:
Mailing address:
  • Phone: 319-360-5041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number03219
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1750574109
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerPENDING

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: