Provider Demographics
NPI:1598289688
Name:LOWELL, HOLLY NOEL (LISW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:NOEL
Last Name:LOWELL
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 1:6540 DAKOTA DR
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2431
Mailing Address - Country:US
Mailing Address - Phone:515-770-4376
Mailing Address - Fax:
Practice Address - Street 1:3004 30TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5259
Practice Address - Country:US
Practice Address - Phone:515-277-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical