Provider Demographics
NPI:1245495027
Name:BLES, JULIET ANNE (LISW)
Entity type:Individual
Prefix:MS
First Name:JULIET
Middle Name:ANNE
Last Name:BLES
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 1:1801 HICKMAN ROAD
Mailing Address - Street 2:BROADLAWNS MEDICAL CENTER
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314
Mailing Address - Country:US
Mailing Address - Phone:515-282-6882
Mailing Address - Fax:515-282-6870
Practice Address - Street 1:1801 HICKMAN ROAD
Practice Address - Street 2:BROADLAWNS MEDICAL CENTER
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314
Practice Address - Country:US
Practice Address - Phone:515-282-6882
Practice Address - Fax:515-282-6870
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA065121041C0700X, 104100000X
1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool