Organization
PARENT ENRICHMENT PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CATHERINE ANN VICKROY LISW (PRESIDENT LISW)
(515) 250-9759
Entity
Organization
Contact information
Practice address
9339 LAKEWOOD CIRCLE, NORWALK, IA 50211-1867
(515) 250-9759
(515) 285-4876
Mailing address
9339 LAKEWOOD CIRCLE, NORWALK, IA 50211-1867
(515) 250-9759
(515) 285-4876
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LISW01215
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0472548
MEDICAID MENTAL HEALTH WAIVER
IA
05
—
0472548
—
IA
05
—
0733923
—
IA
Enumeration date
04/13/2007
Last updated
07/17/2008
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