Healthcare Provider Details

I. General information

NPI: 1003723495
Provider Name (Legal Business Name): CAMILLA MICHELLE LAWRENCE LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5375 21ST AVE
MARION IA
52302-9159
US

IV. Provider business mailing address

5375 21ST AVE
MARION IA
52302-9159
US

V. Phone/Fax

Practice location:
  • Phone: 319-396-1066
  • Fax: 319-396-8779
Mailing address:
  • Phone: 319-396-1066
  • Fax: 319-396-8779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number05800
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: