Provider Demographics
NPI:1750949699
Name:WEST, KEVIN DOUGLAS (LISW)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DOUGLAS
Last Name:WEST
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4401 WESTOWN PKWY STE 280
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-6721
Mailing Address - Country:US
Mailing Address - Phone:515-255-2224
Mailing Address - Fax:515-255-2228
Practice Address - Street 1:4401 WESTOWN PKWY
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6721
Practice Address - Country:US
Practice Address - Phone:515-255-2224
Practice Address - Fax:515-255-2228
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA042541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical