Healthcare Provider Details

I. General information

NPI: 1184878365
Provider Name (Legal Business Name): DANA WYLIE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 48TH ST SUITE 2
DES MOINES IA
50310-1988
US

IV. Provider business mailing address

PO BOX 4925
DES MOINES IA
50305-4925
US

V. Phone/Fax

Practice location:
  • Phone: 515-271-6300
  • Fax: 515-271-6311
Mailing address:
  • Phone: 515-271-6300
  • Fax: 515-271-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number212
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: