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NPI Code Detail

MEDICARE: DANIEL E JENS LISW

MEDICARE: DANIEL E JENS 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 Worker03213IA

General Provider Information

NPI Number : 1164410924
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL E JENS LISW
Provider Business Mailing Address
First Line : 2485 TECH DR
Second Line :
City : BETTENDORF
State : IA
Zip : 52722-3262
Country : US
Telephone Number : 563-355-1611
Fax Number : 563-355-6617
Provider Business Practice Location Address
First Line : 2485 TECH DR
Second Line :
City : BETTENDORF
State : IA
Zip : 52722-3262
Country : US
Telephone Number : 563-355-1611
Fax Number : 563-355-6617
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2005
Last Update Date : 06/22/2009

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