Healthcare Provider Details

I. General information

NPI: 1184382061
Provider Name (Legal Business Name): ABIGAIL LIEB LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ABIGAIL RAHLF LISW

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 11/20/2022
Certification Date: 11/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 KEY WAY STE A
DUBUQUE IA
52002-3857
US

IV. Provider business mailing address

2223 KEY WAY STE A
DUBUQUE IA
52002-3857
US

V. Phone/Fax

Practice location:
  • Phone: 563-556-5000
  • Fax:
Mailing address:
  • Phone: 563-556-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number096100
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: