Healthcare Provider Details

I. General information

NPI: 1255361374
Provider Name (Legal Business Name): JANICE OBRIANT LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 30TH ST
DES MOINES IA
50310-5753
US

IV. Provider business mailing address

3600 30TH ST
DES MOINES IA
50310-5753
US

V. Phone/Fax

Practice location:
  • Phone: 515-699-5999
  • Fax: 515-699-5926
Mailing address:
  • Phone: 515-699-5999
  • Fax: 515-699-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00892
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: