Provider Demographics
NPI:1437145349
Name:NOLAND, KATHY (LISW)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:NOLAND
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1505
Mailing Address - Country:US
Mailing Address - Phone:515-243-5181
Mailing Address - Fax:515-243-2760
Practice Address - Street 1:1301 CENTER ST.
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1505
Practice Address - Country:US
Practice Address - Phone:515-243-5181
Practice Address - Fax:515-243-2760
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00774104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0074583Medicaid
IA0074583Medicaid