Provider Demographics
NPI:1730615881
Name:KELLEY EDWARDS, DENISE LAUREN (LISW)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:LAUREN
Last Name:KELLEY EDWARDS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:L
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:5465 MILLS CIVIC PKWY STE 3319
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5318
Mailing Address - Country:US
Mailing Address - Phone:515-322-7986
Mailing Address - Fax:
Practice Address - Street 1:5550 WILD ROSE LN STE 400
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5351
Practice Address - Country:US
Practice Address - Phone:515-322-7986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086198104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker