Healthcare Provider Details

I. General information

NPI: 1417077264
Provider Name (Legal Business Name): STEPHEN E PRETTYMAN LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2154 125TH ST
FAIRFIELD IA
52556-8962
US

IV. Provider business mailing address

2154 125TH ST
FAIRFIELD IA
52556-8962
US

V. Phone/Fax

Practice location:
  • Phone: 641-919-2474
  • Fax:
Mailing address:
  • Phone: 641-919-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06375
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: