=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063516185
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID BRIAN GREENWOOD LISW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6900 UNIVERSITY AVENUE SUITE 135
-----------------------------------------------------
City | WINDSOR HEIGHTS
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50311-1505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-243-1020
-----------------------------------------------------
Fax | 515-883-1946
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6900 UNIVERSITY AVENUE SUITE 135
-----------------------------------------------------
City | WINDSOR HEIGHTS
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50311-1505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-243-1020
-----------------------------------------------------
Fax | 515-883-1946
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 01069
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------