MEDICARE: ABBEY N WILLIS LMSW

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
1	1041C0700X	Clinical Social Worker	134558	IA

General Provider Information

NPI Number	:	1194670323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBEY N WILLIS LMSW

Provider Business Mailing Address
First Line	:	5720 INWOOD ST
Second Line	:
City	:	PROLE
State	:	IA
Zip	:	50229-9064
Country	:	US
Telephone Number	:	712-887-0937
Fax Number	:

Provider Business Practice Location Address
First Line	:	1370 NW 114TH ST STE 309
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-7008
Country	:	US
Telephone Number	:	712-887-0937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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