Healthcare Provider Details

I. General information

NPI: 1700379955
Provider Name (Legal Business Name): TORY ANN KEYSER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E COURT AVE STE 200
DES MOINES IA
50309-2058
US

IV. Provider business mailing address

1323 PAYTON AVE
DES MOINES IA
50315-5052
US

V. Phone/Fax

Practice location:
  • Phone: 515-243-3525
  • Fax: 515-243-3448
Mailing address:
  • Phone: 515-243-3525
  • Fax: 515-243-3448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007356
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: