Healthcare Provider Details

I. General information

NPI: 1720873987
Provider Name (Legal Business Name): TYLAIAH SAULSBERRY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 UNIVERSITY AVE
DES MOINES IA
50311-3423
US

IV. Provider business mailing address

5125 NE 23RD AVE UNIT 3311
PLEASANT HILL IA
50327-7033
US

V. Phone/Fax

Practice location:
  • Phone: 515-996-5935
  • Fax: 515-414-7638
Mailing address:
  • Phone: 515-339-6291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128757
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: