Healthcare Provider Details

I. General information

NPI: 1912042938
Provider Name (Legal Business Name): BRENDA LYNN GERDES LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 WILLSON AVE
WEBSTER CITY IA
50595-2215
US

IV. Provider business mailing address

11963 580TH AVE
STORY CITY IA
50248-8745
US

V. Phone/Fax

Practice location:
  • Phone: 515-979-5661
  • Fax:
Mailing address:
  • Phone: 515-979-5661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number01664
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier100059455001
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerAPS HEALTHCARE
# 2
Identifier9357788
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerMULTI PLAN
# 3
Identifier110623
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerHEALTH ALLIANCE
# 4
Identifier38042
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerWELLMARK BCBS
# 5
Identifier39883
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerWELLMARK BCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: