Healthcare Provider Details

I. General information

NPI: 1235440439
Provider Name (Legal Business Name): STACY MARIE NEAGLES LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 WESTERVILLE ST
LINN GROVE IA
51033-1018
US

IV. Provider business mailing address

204 WESTERVILLE ST
LINN GROVE IA
51033-1018
US

V. Phone/Fax

Practice location:
  • Phone: 712-299-9396
  • Fax:
Mailing address:
  • Phone: 712-299-9396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113194
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: