Healthcare Provider Details

I. General information

NPI: 1962133728
Provider Name (Legal Business Name): LISA SUE SMITH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA RAJPUT

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 COURT AVE STE 241
DES MOINES IA
50309-2282
US

IV. Provider business mailing address

309 COURT AVE STE 241
DES MOINES IA
50309-2282
US

V. Phone/Fax

Practice location:
  • Phone: 515-901-2974
  • Fax:
Mailing address:
  • Phone: 515-901-2974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number113014
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: