| Kathe Irvine Lisw Pllc | |
|
3408 Woodland Ave Ste 403b West Des Moines IA 50266-6506 | |
| (515) 554-9866 | |
| Not Available |
| Full Name | Kathe Irvine Lisw Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3408 Woodland Ave Ste 403b, West Des Moines, Iowa |
| Authorized Official Name and Position | Kathe N Irvine (OWNER) |
| Authorized Official Contact | 5155549866 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kathe Irvine Lisw Pllc 207 Caulder Ave Des Moines IA 50315-7612 Ph: (515) 554-9866 | Kathe Irvine Lisw Pllc 3408 Woodland Ave Ste 403b West Des Moines IA 50266-6506 Ph: (515) 554-9866 |
| NPI Number | 1457921785 |
|---|---|
| Provider Enumeration Date | 06/29/2021 |
| Last Update Date | 07/06/2021 |
| Certification Date | 07/06/2021 |
| Medicare PECOS PAC ID | 4385048883 |
|---|---|
| Medicare Enrollment ID | O20210805001223 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457921785 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kathe Nadine Irvine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194108464 PECOS PAC ID: 7719253996 Enrollment ID: I20171017001627 |
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