Healthcare Provider Details

I. General information

NPI: 1225595051
Provider Name (Legal Business Name): TORI M KESTER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 CENTER ST STE 17
DES MOINES IA
50309-1016
US

IV. Provider business mailing address

3305 NW AMHERST LN APT 201
ANKENY IA
50023-0022
US

V. Phone/Fax

Practice location:
  • Phone: 515-699-5999
  • Fax: 515-288-3945
Mailing address:
  • Phone: 563-542-5056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number091149
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number091149
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: