Healthcare Provider Details

I. General information

NPI: 1114912870
Provider Name (Legal Business Name): KAREN LEE OLMSTEAD LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN LEE MCGOWAN

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-0843
  • Fax: 319-353-7788
Mailing address:
  • Phone: 319-356-0843
  • Fax: 319-353-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number00135
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00135
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: