Provider Demographics
NPI:1386705796
Name:LANUS, JAMIE MARIE (MSW, LISW)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:MARIE
Last Name:LANUS
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 S FREDERICK AVE
Mailing Address - Street 2:P.O. BOX 113
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662-2305
Mailing Address - Country:US
Mailing Address - Phone:319-283-5774
Mailing Address - Fax:319-283-5775
Practice Address - Street 1:36 S FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-2305
Practice Address - Country:US
Practice Address - Phone:319-283-5774
Practice Address - Fax:319-283-5775
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA061551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA06155OtherLISW