Healthcare Provider Details

I. General information

NPI: 1497135115
Provider Name (Legal Business Name): MELISSA ZIZIS LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 8TH ST #5
WEST DES MOINES IA
50265
US

IV. Provider business mailing address

1308 8TH ST #5
WEST DES MOINES IA
50265-2649
US

V. Phone/Fax

Practice location:
  • Phone: 515-276-6338
  • Fax:
Mailing address:
  • Phone: 515-276-6338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number076914
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: