Provider Demographics
NPI:1861485492
Name:FRANKLIN, RAY LEO (LISW)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:LEO
Last Name:FRANKLIN
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:RAYMOND
Other - Middle Name:LEO
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:306 N 3RD AVE E
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3249
Mailing Address - Country:US
Mailing Address - Phone:641-792-4012
Mailing Address - Fax:641-791-0697
Practice Address - Street 1:701 RIVERVIEW ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2343
Practice Address - Country:US
Practice Address - Phone:888-948-6789
Practice Address - Fax:877-345-3501
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05132104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA420681060C9OtherJOHN DEERE HEALTH
IA25848OtherWELLMARK INC BCBS
IA420681060C9OtherUNITED BEHAVIORAL HEALTH
IAI018OtherTRIWEST
IA420681060C9OtherJOHN DEERE HEALTH
IAI018OtherTRIWEST