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General NPI Number Information
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NPI Number | 1932778610
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Entity Type | Individual
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Provider Name | CAROLYN HOLLISTER LISW
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Gender | Female
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Dates
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Enumeration Date | 06/17/2021
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 1605 N ANKENY BLVD STE 110
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City | ANKENY
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State | IA
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Zip | 50023-4163
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Country | US
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Telephone | 515-520-8164
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Fax | 515-209-7756
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Provider Business Mailing Address
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Address Line | 1605 N ANKENY BLVD STE 110
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City | ANKENY
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State | IA
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Zip | 50023-4163
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Country | US
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Telephone | 515-402-1047
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Fax |
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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 | 107365
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License Number State | IA
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