Healthcare Provider Details

I. General information

NPI: 1851224554
Provider Name (Legal Business Name): JOANNA WOLCH LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MERCY DR
DUBUQUE IA
52001-7320
US

IV. Provider business mailing address

PO BOX 477
HAZEL GREEN WI
53811-0477
US

V. Phone/Fax

Practice location:
  • Phone: 563-589-8170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number109371
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: