| Dustin Daugherty, Lisw, Llc | |
|
1200 Valley West Dr Ste 206-08 West Des Moines IA 50266-1938 | |
| (515) 868-0445 | |
| (515) 225-7546 |
| Full Name | Dustin Daugherty, Lisw, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1200 Valley West Dr Ste 206-08, West Des Moines, Iowa |
| Authorized Official Name and Position | Dustin Lee Daugherty (OWNER/CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 5158680445 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dustin Daugherty, Lisw, Llc 1200 Valley West Dr Ste 206-08 West Des Moines IA 50266-1938 Ph: (515) 868-0445 | Dustin Daugherty, Lisw, Llc 1200 Valley West Dr Ste 206-08 West Des Moines IA 50266-1938 Ph: (515) 868-0445 |
| NPI Number | 1841563806 |
|---|---|
| Provider Enumeration Date | 02/21/2012 |
| Last Update Date | 02/21/2012 |
| Medicare PECOS PAC ID | 9133380553 |
|---|---|
| Medicare Enrollment ID | O20120411000830 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841563806 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 007035 (Iowa) | Primary |
| Provider Name | Dustin L Daugherty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396912481 PECOS PAC ID: 8123289543 Enrollment ID: I20120411000847 |
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