Provider Demographics
NPI:1114562402
Name:THOMAS, AARON M (MSW, LCSW, LISW)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MSW, LCSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-1647
Mailing Address - Country:US
Mailing Address - Phone:563-388-1039
Mailing Address - Fax:
Practice Address - Street 1:2711 W 63RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-1647
Practice Address - Country:US
Practice Address - Phone:563-388-1039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0247411041C0700X
IA1012141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical