Provider Demographics
NPI:1760411060
Name:HEJTMANEK, LAWRENCE (LISW)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:HEJTMANEK
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:4908 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1901
Practice Address - Country:US
Practice Address - Phone:515-280-4930
Practice Address - Fax:515-309-0686
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0074583Medicaid
IA45598Medicare ID - Type Unspecified
IA07458OtherWELLMARK/BLUE CROSS