Healthcare Provider Details

I. General information

NPI: 1215701040
Provider Name (Legal Business Name): JESSICA ANN BROWN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 NW 114TH ST STE 309
CLIVE IA
50325-7008
US

IV. Provider business mailing address

660 E 5TH ST # B111
DES MOINES IA
50309-5469
US

V. Phone/Fax

Practice location:
  • Phone: 515-949-6918
  • Fax:
Mailing address:
  • Phone: 563-451-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107847
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: