Healthcare Provider Details

I. General information

NPI: 1720558422
Provider Name (Legal Business Name): MEGAN M CLEWELL LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN WULF

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 W NORTH AVE
NORWALK IA
50211-9145
US

IV. Provider business mailing address

PO BOX 154
NORWALK IA
50211-0154
US

V. Phone/Fax

Practice location:
  • Phone: 515-971-1015
  • Fax:
Mailing address:
  • Phone: 515-720-5939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number091404
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: