Individual provider Active NPI

Lacey Kristine Brooks, LISW

  • Clinical Social Worker
  • Fairfield, IA
National Provider Identifier
1174166342
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
007699 Issued in IA
Practice address
406 E Madison Ave
Fairfield, IA 52556-3645
Phone
(641) 683-5773
Fax
(641) 226-5759
NPI assigned
Oct 21, 2019
Last updated
May 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 007699 IA Primary

Addresses

Primary practice location

406 E Madison Ave
Fairfield, IA 52556-3645

Mailing address

PO Box 458
Ottumwa, IA 52501-0458
Phone (641) 684-6896

Other practice location 1

114 W Main St
Richland, IA 52585
Phone (641) 895-2149

Other names 1

  • Lacey Dickey Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Oct 20, 2025 through Oct 20, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
007699IAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
River Hills Community Health Center Inc. CurrentSince Oct 27, 2019 Accepting new patients
River Hills Community Health Center Inc. PastSince Oct 27, 2019 Accepting new patients

Locations

406 E Madison Ave
Fairfield, IA 52556

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1174166342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 458",
            "city": "OTTUMWA",
            "state": "IA",
            "postal_code": "525010458",
            "telephone_number": "641-684-6896",
            "fax_number": "641-226-5759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 E MADISON AVE",
            "city": "FAIRFIELD",
            "state": "IA",
            "postal_code": "525563645",
            "telephone_number": "641-683-5773",
            "fax_number": "641-226-5759"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "114 W Main St",
            "address_purpose": "LOCATION",
            "city": "Richland",
            "state": "IA",
            "postal_code": "52585",
            "country_code": "US",
            "telephone_number": "641-895-2149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "LACEY",
        "middle_name": "KRISTINE",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-21",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "007699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LACEY",
            "last_name": "DICKEY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fairfield, IA

Sources for this page

Verify at the official NPI Registry.