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NPI Code Detail

MEDICARE: KELLY RENNICK O'BERRY LISW

MEDICARE: KELLY RENNICK O'BERRY 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
1104100000XSocial Worker06475IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861757148
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY RENNICK O'BERRY LISW
Provider Business Mailing Address
First Line : 7755 OFFICE PLAZA DR N
Second Line : SUITE 105
City : WEST DES MOINES
State : IA
Zip : 50266-2339
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7755 OFFICE PLAZA DR N
Second Line : SUITE 105
City : WEST DES MOINES
State : IA
Zip : 50266-2339
Country : US
Telephone Number : 515-201-0439
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2012
Last Update Date : 04/07/2017

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