Healthcare Provider Details

I. General information

NPI: 1861798167
Provider Name (Legal Business Name): ALECIA ANN SMITH LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALECIA ANN DOUGHERTY

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 07/20/2025
Certification Date: 07/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 5TH STREET, PO BOX 136
LAKE VIEW IA
51450
US

IV. Provider business mailing address

PO BOX 136
LAKE VIEW IA
51450-0136
US

V. Phone/Fax

Practice location:
  • Phone: 515-639-0676
  • Fax:
Mailing address:
  • Phone: 515-639-0676
  • Fax: 515-639-0676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06695
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: