Provider Demographics
NPI:1093701922
Name:WALTON, LISA (LISW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WALTON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:PEITZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3436 VILLAGE RUN DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317-4967
Mailing Address - Country:US
Mailing Address - Phone:515-707-5931
Mailing Address - Fax:
Practice Address - Street 1:2340 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5702
Practice Address - Country:US
Practice Address - Phone:515-707-5931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05996104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker