Provider Demographics
NPI:1336648088
Name:L BAXTER LISW LLC
Entity Type:Organization
Organization Name:L BAXTER LISW LLC
Other - Org Name:LISA BAXTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-267-9057
Mailing Address - Street 1:974 73RD ST STE 24
Mailing Address - Street 2:
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50324-1200
Mailing Address - Country:US
Mailing Address - Phone:515-267-9054
Mailing Address - Fax:515-267-9057
Practice Address - Street 1:974 73RD ST STE 24
Practice Address - Street 2:
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50324-1200
Practice Address - Country:US
Practice Address - Phone:515-267-9054
Practice Address - Fax:515-267-9057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty