Healthcare Provider Details

I. General information

NPI: 1477917185
Provider Name (Legal Business Name): LAURA M JOHNSON-PALOMARES B.A., TCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA VOIGT - MAIDEN NAME

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 5TH AVE SUITE 600
DES MOINES IA
50309
US

IV. Provider business mailing address

505 5TH AVE SUITE 600
DES MOINES IA
50309
US

V. Phone/Fax

Practice location:
  • Phone: 515-243-4200
  • Fax: 515-284-5201
Mailing address:
  • Phone: 515-243-4200
  • Fax: 515-284-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: