Provider Demographics
NPI:1306369277
Name:JENNIFER LOCK OMAN, LISW, BCD
Entity Type:Organization
Organization Name:JENNIFER LOCK OMAN, LISW, BCD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCK OMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-277-6133
Mailing Address - Street 1:1001 OFFICE PARK RD STE 206
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2509
Mailing Address - Country:US
Mailing Address - Phone:515-277-6133
Mailing Address - Fax:
Practice Address - Street 1:1001 OFFICE PARK RD STE 206
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2509
Practice Address - Country:US
Practice Address - Phone:515-277-6133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00632261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health