Provider Demographics
NPI:1407147051
Name:STANHOPE, LISA (LBSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:STANHOPE
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3275 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4409
Mailing Address - Country:US
Mailing Address - Phone:319-833-0072
Mailing Address - Fax:319-833-0073
Practice Address - Street 1:3275 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4409
Practice Address - Country:US
Practice Address - Phone:319-833-0072
Practice Address - Fax:319-833-0073
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03548104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker