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General NPI Number Information
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NPI Number | 1447601406
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Entity Type | Individual
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Provider Name | PAMELA MOEN LISW
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Gender | Female
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Dates
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Enumeration Date | 06/30/2016
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 1290 JORDAN ST
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-8020
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Country | US
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Telephone | 319-249-0307
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Fax | 319-358-2367
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Provider Business Mailing Address
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Address Line | 1900 SILVER LAKE RD NW STE 110
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-1789
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Country | US
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Telephone | 651-628-9566
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Fax | 651-628-0411
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 081612
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License Number State | IA
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