Healthcare Provider Details

I. General information

NPI: 1841463205
Provider Name (Legal Business Name): EMILY MEFFORD LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 E 13TH ST
VINTON IA
52349-1843
US

IV. Provider business mailing address

404 W 6TH ST
VINTON IA
52349-1201
US

V. Phone/Fax

Practice location:
  • Phone: 319-560-9528
  • Fax:
Mailing address:
  • Phone: 319-560-9528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006887
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number006887
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: