Provider Demographics
NPI:1790882884
Name:BAXTER, LISA M (LISW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BAXTER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 73RD ST STE 24
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-1200
Mailing Address - Country:US
Mailing Address - Phone:515-267-9054
Mailing Address - Fax:515-267-9057
Practice Address - Street 1:974 73RD ST STE 24
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-1200
Practice Address - Country:US
Practice Address - Phone:515-267-9054
Practice Address - Fax:515-267-9057
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA029131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI16516Medicare PIN