Healthcare Provider Details

I. General information

NPI: 1760984942
Provider Name (Legal Business Name): RENAE ANNETTE RICHTSMEIER NORTHCUTT LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 1ST AVE E. #200
NEWTON IA
50208-3981
US

IV. Provider business mailing address

1502 W 9TH ST S
NEWTON IA
50208-5369
US

V. Phone/Fax

Practice location:
  • Phone: 641-792-4012
  • Fax: 641-791-0697
Mailing address:
  • Phone: 641-521-9402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number097898
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number097898
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: