Provider Demographics
NPI:1902838261
Name:FEIN, LAURIE A (LISW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:FEIN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 NW IRVINEDALE DR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-8962
Mailing Address - Country:US
Mailing Address - Phone:515-964-1733
Mailing Address - Fax:
Practice Address - Street 1:412 NW IRVINEDALE DRIVE
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-8962
Practice Address - Country:US
Practice Address - Phone:515-314-5655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01501104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA45694OtherWELLMARK
IA1262147Medicaid
IA1262147Medicaid