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General NPI Number Information
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NPI Number | 1700265451
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Entity Type | Individual
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Provider Name | AUSTIN CROSS L.I.S.W
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Gender | Male
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 05/28/2015
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Provider Practice Location Address
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Address Line | 3510 LINCOLN WAY
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City | AMES
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State | IA
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Zip | 50014-7533
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Country | US
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Telephone | 515-232-0628
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Fax | 515-232-0727
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Provider Business Mailing Address
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Address Line | 9943 HICKMAN RD SUITE 105
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City | URBANDALE
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State | IA
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Zip | 50322-5304
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Country | US
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Telephone | 515-248-1447
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Fax | 515-248-1440
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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 | 008018
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License Number State | IA
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