Healthcare Provider Details

I. General information

NPI: 1225027238
Provider Name (Legal Business Name): RICHARD L JOENS L.I.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 INGERSOLL AVE SUITE 108
DES MOINES IA
50312-3534
US

IV. Provider business mailing address

3900 INGERSOLL AVE SUITE 108
DES MOINES IA
50312-3534
US

V. Phone/Fax

Practice location:
  • Phone: 515-279-6200
  • Fax: 515-279-4528
Mailing address:
  • Phone: 515-279-6200
  • Fax: 515-279-4528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number01012
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: