MEDICARE: SARAH KOENEN 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
1	1041C0700X	Clinical Social Worker	095259	IA

General Provider Information

NPI Number	:	1265087456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH KOENEN LISW

Provider Business Mailing Address
First Line	:	1603 22ND ST STE 203
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1410
Country	:	US
Telephone Number	:	515-599-6030
Fax Number	:	515-257-7648

Provider Business Practice Location Address
First Line	:	1603 22ND ST STE 203
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1410
Country	:	US
Telephone Number	:	515-599-6030
Fax Number	:	515-257-7648

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

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	04/21/2026

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