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NPI Code Detail

MEDICARE: KATHLEEN J LACEY LISW

MEDICARE: KATHLEEN J LACEY 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
1104100000XSocial Worker007720IA
21041C0700XClinical Social Worker007720IA

General Provider Information

NPI Number : 1154617934
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN J LACEY LISW
Provider Business Mailing Address
First Line : 1900 SILVER LAKE RD NW STE 110
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-1789
Country : US
Telephone Number : 651-628-9566
Fax Number : 651-628-0411
Provider Business Practice Location Address
First Line : 1105 N ANKENY BLVD STE 100
Second Line :
City : ANKENY
State : IA
Zip : 50023-4003
Country : US
Telephone Number : 515-255-8399
Fax Number : 515-644-8225
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2011
Last Update Date : 06/25/2025

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Directions to “ KATHLEEN J LACEY LISW” Practice Location

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