Provider Demographics
NPI:1821067844
Name:WHITE, JEANNE LOUISE (LISW)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:LOUISE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:LOUISE
Other - Last Name:CLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1003 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-3502
Mailing Address - Country:US
Mailing Address - Phone:515-267-1003
Mailing Address - Fax:515-267-0100
Practice Address - Street 1:1003 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-3502
Practice Address - Country:US
Practice Address - Phone:515-267-1003
Practice Address - Fax:515-267-0100
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA46025OtherBLUE SHIELD
IA1045898Medicaid
IAIA0124OtherJOHN DEERE HC
05025Medicare ID - Type Unspecified