Healthcare Provider Details

I. General information

NPI: 1407463722
Provider Name (Legal Business Name): BETH GARZA LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 JOHN F KENNEDY RD APT 204
DUBUQUE IA
52002-3865
US

IV. Provider business mailing address

2115 JOHN F KENNEDY RD SUITE 204
DUBUQUE IA
52002-3865
US

V. Phone/Fax

Practice location:
  • Phone: 563-341-7440
  • Fax:
Mailing address:
  • Phone: 563-340-7441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number090569
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: