MEDICARE: KIMBERLEE HERMAN 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	101Y00000X	Counselor	11286	AZ

General Provider Information

NPI Number	:	1750316550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEE HERMAN LISW

Provider Business Mailing Address
First Line	:	3808 RIVERSIDE DR NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52411-7412
Country	:	US
Telephone Number	:	319-431-3930
Fax Number	:

Provider Business Practice Location Address
First Line	:	3808 RIVERSIDE DR NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52411-7412
Country	:	US
Telephone Number	:	319-431-3930
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	05/01/2009

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Directions to “ KIMBERLEE HERMAN LISW” Practice Location

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