MEDICARE: DEVONA DIVOKY SIRON 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	007743	IA

General Provider Information

NPI Number	:	1669767869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVONA DIVOKY SIRON LISW

Provider Business Mailing Address
First Line	:	332 S LINN ST STE 36
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-1608
Country	:	US
Telephone Number	:	319-800-5819
Fax Number	:

Provider Business Practice Location Address
First Line	:	332 S LINN ST STE 36
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-1608
Country	:	US
Telephone Number	:	319-800-5819
Fax Number	:

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

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	03/17/2021

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Directions to “ DEVONA DIVOKY SIRON LISW” Practice Location

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