MEDICARE: DIANA SUE MCPECK 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	01224	IA

General Provider Information

NPI Number	:	1386734507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA SUE MCPECK LISW

Provider Business Mailing Address
First Line	:	1701 48TH ST STE 120
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-6723
Country	:	US
Telephone Number	:	515-331-0303
Fax Number	:	515-331-9086

Provider Business Practice Location Address
First Line	:	1701 48TH ST STE 120
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-6723
Country	:	US
Telephone Number	:	515-331-0303
Fax Number	:	515-331-9086

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	03/06/2023

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