Provider Demographics
NPI:1720558422
Name:CLEWELL, MEGAN M (LISW)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:M
Last Name:CLEWELL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:WULF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4774 DEVLIN DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:IA
Mailing Address - Zip Code:50211-1880
Mailing Address - Country:US
Mailing Address - Phone:515-720-5939
Mailing Address - Fax:
Practice Address - Street 1:2501 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-5342
Practice Address - Country:US
Practice Address - Phone:515-971-1015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091404104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA091404OtherSOCIAL WORKER MASTERS LEVEL