Provider Demographics
NPI:1992792618
Name:GILBERT, TERESA J (LISW)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:J
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:J
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-9030
Mailing Address - Fax:515-643-9031
Practice Address - Street 1:6601 SW 9TH ST STE 2
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-6138
Practice Address - Country:US
Practice Address - Phone:515-643-9030
Practice Address - Fax:515-643-9031
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00939104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
7622174OtherAETNA
IA70179OtherWELLMARK BCBS
2276079OtherCIGNA
029456OtherVALUE OPTIONS