Provider Demographics
NPI:1861578411
Name:LIAUTAUD, MARGARET A (LISW)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:A
Last Name:LIAUTAUD
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:A
Other - Last Name:LIAUTAUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW
Mailing Address - Street 1:421 E SHORE DR
Mailing Address - Street 2:PO BOX 710
Mailing Address - City:LAKE VIEW
Mailing Address - State:IA
Mailing Address - Zip Code:51450-7497
Mailing Address - Country:US
Mailing Address - Phone:712-657-2211
Mailing Address - Fax:712-657-2106
Practice Address - Street 1:421 E SHORE DR
Practice Address - Street 2:
Practice Address - City:LAKE VIEW
Practice Address - State:IA
Practice Address - Zip Code:51450-7497
Practice Address - Country:US
Practice Address - Phone:712-657-2211
Practice Address - Fax:712-657-2106
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA11756Medicare UPIN