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General NPI Number Information
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NPI Number | 1972753564
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Entity Type | Individual
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Provider Name | LISA LYNN KINNEY L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 09/19/2008
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Last Update Date | 09/19/2008
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Provider Practice Location Address
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Address Line | 2979 VICTORIA STREET QUAD CITIESVA OUTPATIENT CLINIC
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City | BETTENDORF
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State | IA
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Zip | 52722
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Country | US
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Telephone | 563-599-9982
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Fax |
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Provider Business Mailing Address
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Address Line | 601 HIGHWAY 6 WEST VA HOSPITAL
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City | IOWA CITY
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State | IA
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Zip | 52246-2208
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Country | US
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Telephone | 563-599-9982
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 178.003182
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License Number State | IL
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