Provider Demographics
NPI:1306285473
Name:RAYMER, TONY JAMES (LISW, RPT-S)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:JAMES
Last Name:RAYMER
Suffix:
Gender:M
Credentials:LISW, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NE 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50313-1243
Mailing Address - Country:US
Mailing Address - Phone:515-309-2368
Mailing Address - Fax:515-289-1281
Practice Address - Street 1:401 NE 66TH AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50313-1243
Practice Address - Country:US
Practice Address - Phone:515-309-2368
Practice Address - Fax:515-289-1281
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0082111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical