Healthcare Provider Details

I. General information

NPI: 1609528769
Provider Name (Legal Business Name): DIAMOND DENNEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 UNIVERSITY AVE
DES MOINES IA
50311-3423
US

IV. Provider business mailing address

340 SW 7TH ST UNIT 326
DES MOINES IA
50309-4655
US

V. Phone/Fax

Practice location:
  • Phone: 515-410-1716
  • Fax:
Mailing address:
  • Phone: 712-490-7432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number097351
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: