MEDICARE: AMY CHRISTINE MASON 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	008311	IA

General Provider Information

NPI Number	:	1972983088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY CHRISTINE MASON LISW

Provider Business Mailing Address
First Line	:	2140 NORCOR AVE STE 101
Second Line	:
City	:	CORALVILLE
State	:	IA
Zip	:	52241-9736
Country	:	US
Telephone Number	:	319-354-1235
Fax Number	:	319-409-6600

Provider Business Practice Location Address
First Line	:	2140 NORCOR AVE STE 101
Second Line	:
City	:	CORALVILLE
State	:	IA
Zip	:	52241-9736
Country	:	US
Telephone Number	:	319-354-1235
Fax Number	:	319-409-6600

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

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	09/15/2025

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