Provider Demographics
NPI:1386493609
Name:POOL, PAYTON L (LMSW)
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:L
Last Name:POOL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5138
Mailing Address - Country:US
Mailing Address - Phone:319-433-0395
Mailing Address - Fax:
Practice Address - Street 1:2023 CEDAR PLAZA DR STE 1
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2392
Practice Address - Country:US
Practice Address - Phone:888-316-3025
Practice Address - Fax:319-433-3870
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA125149104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker