Healthcare Provider Details

I. General information

NPI: 1487179958
Provider Name (Legal Business Name): AARON L CULLEY LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 CHADWICK RD STE 2
CEDAR FALLS IA
50613-8091
US

IV. Provider business mailing address

146 W DALE ST STE 101
WATERLOO IA
50703-1901
US

V. Phone/Fax

Practice location:
  • Phone: 319-255-5660
  • Fax:
Mailing address:
  • Phone: 319-226-2119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number077789
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number077789
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: