MEDICARE: LAWRENCE HEJTMANEK 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	00096	IA

General Provider Information

NPI Number	:	1760411060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE HEJTMANEK LISW

Provider Business Mailing Address
First Line	:	2213 GRAND AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50312-5305
Country	:	US
Telephone Number	:	515-237-3974
Fax Number	:	515-883-2692

Provider Business Practice Location Address
First Line	:	4908 FRANKLIN AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50310-1901
Country	:	US
Telephone Number	:	515-280-4930
Fax Number	:	515-309-0686

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

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	05/23/2016

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