MEDICARE: DUSTIN DAUGHERTY

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1396912481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN DAUGHERTY

Provider Business Mailing Address
First Line	:	1200 VALLEY WEST DR
Second Line	:	STE 408
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1942
Country	:	US
Telephone Number	:	515-868-0444
Fax Number	:	515-225-7546

Provider Business Practice Location Address
First Line	:	1200 VALLEY WEST DR
Second Line	:	STE 204
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1902
Country	:	US
Telephone Number	:	515-868-0444
Fax Number	:	515-225-7546

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

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	11/20/2018

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Directions to “ DUSTIN DAUGHERTY ” Practice Location

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