Healthcare Provider Details

I. General information

NPI: 1861485492
Provider Name (Legal Business Name): RAY LEO FRANKLIN LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RAYMOND LEO FRANKLIN

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 RIVERVIEW ST
DES MOINES IA
50316-2343
US

IV. Provider business mailing address

306 N 3RD AVE E
NEWTON IA
50208-3249
US

V. Phone/Fax

Practice location:
  • Phone: 888-948-6789
  • Fax: 877-345-3501
Mailing address:
  • Phone: 641-792-4012
  • Fax: 641-791-0697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number05132
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: