Provider Demographics
NPI:1174597751
Name:BELLOWS, LISA J (LISW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:BELLOWS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:J
Other - Last Name:ALBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:54944 221ST ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-6041
Mailing Address - Country:US
Mailing Address - Phone:402-657-2133
Mailing Address - Fax:
Practice Address - Street 1:300 W BROADWAY STE 270
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9028
Practice Address - Country:US
Practice Address - Phone:712-256-7511
Practice Address - Fax:712-256-9766
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA057451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA34713OtherWELLMARK
IA236012OtherMIDLANDS CHOICE