Provider Demographics
NPI:1275535890
Name:PEITZMEIER, CARRIE JOAN (LISW, RD, LD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:JOAN
Last Name:PEITZMEIER
Suffix:
Gender:F
Credentials:LISW, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 INGERSOLL AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-3534
Mailing Address - Country:US
Mailing Address - Phone:515-255-2224
Mailing Address - Fax:515-255-2228
Practice Address - Street 1:3900 INGERSOLL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-3534
Practice Address - Country:US
Practice Address - Phone:515-255-2224
Practice Address - Fax:515-255-2228
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00000133V00000X
IA041981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1442003Medicare PIN