Provider Demographics
NPI:1801635941
Name:ISSA, KATHLEEN (LISW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ISSA
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:ISSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW
Mailing Address - Street 1:5984 APPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WDM
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2836
Mailing Address - Country:US
Mailing Address - Phone:515-556-7298
Mailing Address - Fax:
Practice Address - Street 1:2708 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-5218
Practice Address - Country:US
Practice Address - Phone:515-556-7298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0970901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical