Healthcare Provider Details

I. General information

NPI: 1295097020
Provider Name (Legal Business Name): KATIE COLLEEN ZOSKE LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 N 4TH AVE
MARSHALLTOWN IA
50158-1836
US

IV. Provider business mailing address

9 N 4TH AVE
MARSHALLTOWN IA
50158-1836
US

V. Phone/Fax

Practice location:
  • Phone: 641-752-1585
  • Fax: 641-752-9665
Mailing address:
  • Phone: 641-691-8977
  • Fax: 641-752-9665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number06637
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: