Healthcare Provider Details

I. General information

NPI: 1306369277
Provider Name (Legal Business Name): JENNIFER LOCK OMAN, LISW, BCD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 OFFICE PARK RD STE 206
WEST DES MOINES IA
50265-2509
US

IV. Provider business mailing address

1001 OFFICE PARK RD STE 206
WEST DES MOINES IA
50265-2509
US

V. Phone/Fax

Practice location:
  • Phone: 515-277-6133
  • Fax:
Mailing address:
  • Phone: 515-277-6133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number00632
License Number StateIA

VIII. Authorized Official

Name: JENNIFER LOCK OMAN
Title or Position: OWNER
Credential: LISW
Phone: 515-277-6133