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General NPI Number Information
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NPI Number | 1336487016
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Entity Type | Organization
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Legal Business Name | EYWA HEALTH, INC
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Dates
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Enumeration Date | 01/30/2013
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 333 SW 9TH ST SUITE J
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City | DES MOINES
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State | IA
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Zip | 50309-4440
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Country | US
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Telephone | 515-777-3075
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Fax | 515-777-1719
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Provider Business Mailing Address
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Address Line | 147 PAINE ST SE STE J
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City | BONDURANT
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State | IA
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Zip | 50035-1003
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Country | US
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Telephone | 515-554-0878
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Fax | 515-777-1719
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Authorized Official
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Title or Position | DIRECTOR OUTPATIENT SERVICES
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Name | GLORIA TALLULAH KRAUSE
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Credential | LISW
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Telephone | 515-554-0878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 007236
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License Number State | IA
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