Healthcare Provider Details

I. General information

NPI: 1831138635
Provider Name (Legal Business Name): EDWARD RUND LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST COURT STE 200
DES MOINES IA
50309-2021
US

IV. Provider business mailing address

301 W BURLINGTON
FAIRFIELD IA
52556-3242
US

V. Phone/Fax

Practice location:
  • Phone: 515-243-3525
  • Fax: 515-243-3448
Mailing address:
  • Phone: 515-282-2319
  • Fax: 515-282-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number01205
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number01205
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: