=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912917360
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENISE M ADEN LISW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1970 SPRUCE HILLS DR
-----------------------------------------------------
City | BETTENDORF
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52722-2681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-213-5100
-----------------------------------------------------
Fax | 888-867-3248
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1970 SPRUCE HILLS DR
-----------------------------------------------------
City | BETTENDORF
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52722-2681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-213-5100
-----------------------------------------------------
Fax | 888-867-3248
-----------------------------------------------------
=====================================================
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 | 149-002431
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 05987
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------