Healthcare Provider Details

I. General information

NPI: 1336996438
Provider Name (Legal Business Name): KATIE E GAFFEY LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 GRAND AVE
DES MOINES IA
50312-5218
US

IV. Provider business mailing address

2708 GRAND AVE
DES MOINES IA
50312-5218
US

V. Phone/Fax

Practice location:
  • Phone: 515-290-5354
  • Fax:
Mailing address:
  • Phone: 515-290-5354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number100256
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: