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NPI Code Detail

MEDICARE: MISS LISA LOUISE DITTMER LISW

MEDICARE: MISS LISA LOUISE DITTMER LISW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker02271IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1IA0127OTHERIAJOHN DEERE HC
249480OTHERIABLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053389155
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS LISA LOUISE DITTMER LISW
Provider Business Mailing Address
First Line : 1003 GRAND AVENUE
Second Line :
City : WEST DES MOINES
State : IA
Zip : 50265-3502
Country : US
Telephone Number : 515-267-1003
Fax Number : 515-267-0100
Provider Business Practice Location Address
First Line : 1003 GRAND AVENUE
Second Line :
City : WEST DES MOINES
State : IA
Zip : 50265-3502
Country : US
Telephone Number : 515-267-1003
Fax Number : 515-267-0100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 07/08/2007

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Directions to “ MISS LISA LOUISE DITTMER LISW” Practice Location

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