1174769152 NPI number — MRS. VALERIE CAMILLE HUNTLEY LISW

Table of content: MRS. VALERIE CAMILLE HUNTLEY LISW (NPI 1174769152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174769152 NPI number — MRS. VALERIE CAMILLE HUNTLEY LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUNTLEY
Provider First Name:
VALERIE
Provider Middle Name:
CAMILLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOERING
Provider Other First Name:
VALERIE
Provider Other Middle Name:
CAMILLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174769152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11333 AURORA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
URBANDALE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50322-7908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-557-3100
Provider Business Mailing Address Fax Number:
515-557-3290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11333 AURORA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
URBANDALE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50322-7908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-557-3100
Provider Business Practice Location Address Fax Number:
515-557-3290
Provider Enumeration Date:
12/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  06077 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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