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General NPI Number Information
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NPI Number | 1982914107
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Entity Type | Individual
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Provider Name | JILL THOMAS LISW
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Gender | Female
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 209 E 1ST ST STE 230
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City | ANKENY
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State | IA
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Zip | 50021-1800
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Country | US
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Telephone | 515-257-6218
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Fax |
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Provider Business Mailing Address
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Address Line | 2010 SW SAGE CIR
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City | ANKENY
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State | IA
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Zip | 50023-8210
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Country | US
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Telephone | 515-971-1153
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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 | 007529
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License Number State | IA
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