Healthcare Provider Details

I. General information

NPI: 1144842949
Provider Name (Legal Business Name): LINDSAY MARIE MILES LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 7TH AVE
MARION IA
52302-5774
US

IV. Provider business mailing address

369 PARK TER SE
CEDAR RAPIDS IA
52403-2819
US

V. Phone/Fax

Practice location:
  • Phone: 747-831-9213
  • Fax:
Mailing address:
  • Phone: 563-564-1268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107114002
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: