Healthcare Provider Details

I. General information

NPI: 1295382869
Provider Name (Legal Business Name): ANASTAZIA MARIE MAZUK LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 7TH AVE SW STE 100
CEDAR RAPIDS IA
52404-2185
US

IV. Provider business mailing address

42 7TH AVE SW STE 100
CEDAR RAPIDS IA
52404-2185
US

V. Phone/Fax

Practice location:
  • Phone: 319-800-2125
  • Fax:
Mailing address:
  • Phone: 319-800-2125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number096003
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: