Provider Demographics
NPI:1609132539
Name:DEGELAU, LORI (LISW)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:DEGELAU
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MRS
Other - First Name:LORALEE
Other - Middle Name:
Other - Last Name:DEGELAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW
Mailing Address - Street 1:1015 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-2839
Mailing Address - Country:US
Mailing Address - Phone:515-570-8269
Mailing Address - Fax:
Practice Address - Street 1:1015 N 29TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-2839
Practice Address - Country:US
Practice Address - Phone:515-570-8269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA027411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical